Maryland Woman Undergoes Novel Eye Socket Surgery to Remove Spinal Tumors

A 19-year-old woman from Maryland is on the path to recovery after a groundbreaking surgery performed at the University of Maryland Medical Center (UMMC) successfully removed potentially deadly cancerous tumors from her spine. The surgical team, led by neurosurgeon Dr. Mohamed Labib, utilized a novel transorbital approach, extracting the tumors through the patient’s eye socket. This marks the first instance of surgeons removing a spinal tumor using this technique, according to a UMMC press release.

Karla Flores was diagnosed with a chordoma, a rare developmental bone tumor, in her spine. The diagnosis came after she began experiencing double vision at the age of 18. Chordomas are exceedingly rare, with only approximately 300 cases diagnosed annually in the United States.

The tumor had aggressively wrapped itself around Flores’ spine and spinal cord, invading the vertebrae in her neck, just below the base of her skull, explained Dr. Labib, who is also an assistant professor of neurosurgery at the University of Maryland School of Medicine.

The surgical team faced significant risks during the procedure. "The primary risks were injuring the brainstem, spinal cord, or major blood vessels with the drill or the fine instruments we used — any of these injuries could have resulted in paralysis or even death," Dr. Labib told Fox News Digital. However, the alternative – leaving the chordoma untreated – was equally dire. Without surgery, the tumor would have continued to grow, placing immense pressure on the spinal cord, ultimately leading to paralysis of her arms and legs and eventual death. Dr. Labib emphasized the high stakes involved in the procedure.

To access the tumor, the surgeons created a "huge surgical corridor" through the eye socket. "It was a straight shot," Dr. Labib explained. "By going through the bottom of the eye socket, we were able to remove a tumor that otherwise would have been very difficult and very risky to address."

The transorbital approach involved a collaborative effort between Dr. Labib and facial plastic and reconstructive surgeon Dr. Kalpesh T. Vakharia. Dr. Vakharia carefully made an incision through the conjunctiva, the transparent membrane protecting the eye, inside the lower eyelid, ensuring minimal disturbance to the eye itself. He then removed the bottom of Flores’ eye socket and a portion of her cheekbone to create the necessary pathway to the spine.

Dr. Vakharia emphasized the team’s commitment to minimizing the aesthetic impact of the surgery. "We wanted to develop a surgical plan where there would be no external scars, and it would be impossible to tell that the patient even had surgery," he said. After Dr. Labib successfully removed the tumor, Dr. Vakharia reconstructed the bottom of the eye socket using a titanium plate and rebuilt the cheek with bone harvested from the patient’s hip.

Dr. Vakharia expressed his enthusiasm about being part of this groundbreaking procedure. "It was amazing to have had the opportunity to be part of surgery that had never been done before," he said.

The transorbital approach offered several advantages, including preventing damage to the eustachian tube, major blood vessels like the jugular vein and internal carotid artery, and nerves that control swallowing and speech, according to Dr. Labib.

Prior to performing the surgery on Flores, Dr. Labib practiced the transorbital procedure extensively on cadavers. He emphasized the importance of body donation in advancing medical knowledge and saving lives. "The fact that people are willing to donate their bodies to science enabled us to do this and saved the life of this young woman," he said.

In addition to the spinal tumors, Flores also had a large tumor around her brainstem, which was removed through two separate procedures via her skull and nose. Dr. Andrea M. Hebert, a UMCC head and neck surgeon, performed the endonasal procedure and assisted in the transorbital surgery.

Dr. Hebert explained that the spinal tumors could have become life-threatening if they had grown to the point of causing significant brain stem compression. She also highlighted the importance of a multidisciplinary approach to treating chordomas due to their high recurrence rate. "Many of these tumors recur, and that’s why we favor a multidisciplinary approach to treatment," she said.

Following the surgeries, Flores underwent radiation therapy to eliminate any remaining cancer cells.

Dr. Labib reported that Flores is recovering well from surgery and radiation therapy and is eager to resume her work and studies. "Karla is doing really well — she’s recovered from surgery and radiation and is ready to get back to work and school," Dr. Labib shared. "She’s an incredibly brave young woman who has faced more than most her age. I expect that same strength of spirit will carry her into a promising future."

Flores is experiencing some nerve damage due to the tumor’s proximity to the brainstem, causing some issues with movement of her left eye. Despite this, she remains positive and grateful for the care she received. "Learning about the spinal and brain tumors was terrifying, but I am so grateful the doctors were able to remove them," said Flores, who plans to pursue her dream of becoming a manicurist. "I’m slowly recovering, and with any problem I have, they help me," she continued. "I keep reminding myself to take one day at a time and know that each step is an accomplishment."

Looking ahead, the UMMC team plans to demonstrate the transorbital procedure this fall to neurosurgeons from around the world at their annual Skull Base surgery course.

Dr. Labib emphasized the potential benefits of the transorbital approach for treating other patients with similar tumors. "When you have such a broadened corridor to reach these tumors, you can completely remove them, which greatly reduces recurrence of the cancer," he said. "We also have other patients who will be receiving similar surgeries in the near future."