Groundbreaking Surgery Removes Rare Spinal Tumor Through Eye Socket

A 19-year-old woman from Maryland is on the road to recovery following an unprecedented surgical procedure to remove a rare spinal tumor. The tumor, a chordoma, threatened her life and was skillfully extracted by a team of surgeons at the University of Maryland Medical Center.

The innovative procedure marked the first instance of a spinal tumor being removed via a transorbital approach, a technique that the surgical team was able to implement successfully. This remarkable surgery not only demonstrated the advancing frontiers of medical science but also offered hope to patients facing similar dire diagnoses.

The Impact of Chordomas

Chordomas are infrequent types of tumors that develop in the spine, with only around 300 cases reported annually in the United States. Karla Flores experienced double vision at age 18, a symptom that ultimately led to her diagnosis just months later. This condition is alarming, particularly given the tumor’s invasive nature, as it had wrapped around her spine and invaded vertebrae in her neck.

Dr. Mohamed Labib, a neurosurgeon at UMMC and an assistant professor at the University of Maryland School of Medicine, shed light on the critical situation. He explained that the tumor’s location put profound pressure on her spinal cord, creating an urgent need for surgical intervention.

High-Stakes Surgery

The surgical process posed multiple risks, including possible injury to vital structures such as the brainstem and spinal cord, which could lead to paralysis or death. Nevertheless, without surgery, the tumor could have continued to grow, worsening her condition and posing a significant risk to her life.

To access the tumor safely, the surgical team devised a unique approach that involved creating a substantial corridor through the eye socket. This innovative channel facilitated safe access to the spinal area, allowing for the tumor’s removal.

Describing the procedure, Dr. Labib noted that entering through the bottom of the eye socket allowed them to tackle the tumor without exposing the more intricate structures surrounding it.

Collaboration Among Specialists

Dr. Kalpesh T. Vakharia, a facial plastic and reconstructive surgeon, collaborated closely with Dr. Labib during the procedure. Vakharia prepared the approach by carefully cutting through the conjunctiva, the membrane that protects the eye, without disturbing the eye itself.

To ensure the patient would bear no external scars, he removed parts of Flores’ eye socket and cheekbone, laying the groundwork for the surgical route. This meticulous planning and execution are crucial in avoiding complications during such delicate procedures.

Once the tumor was excised, Vakharia performed reconstructive surgery, employing a titanium plate to reconstruct the eye socket and bone from Flores’ hip to repair her cheek.

A Milestone in Medical History

This pioneering surgery employs a method that was meticulously practiced on cadavers multiple times prior to being attempted on a live patient. “The donations made by individuals for scientific purposes are invaluable in these scenarios,” Dr. Labib emphasized, noting that such contributions are essential for advancing medical procedures.

Before undergoing the spinal tumor surgery, Flores also had a sizable tumor located around her brainstem. This secondary tumor was managed in two separate procedures performed through her skull and nasal passages. The nature and positioning of these tumors made their removal particularly challenging.

Looking Ahead

Dr. Andrea M. Hebert, a head and neck surgeon at UMMC involved in the surgical process, emphasized the multidisciplinary approach taken in Flores’ treatment. Such thorough coordination is critical, especially with tumors known for their recurrence.

Following her surgical procedures, Flores received radiation therapy aimed at eradicating any remaining cancer cells. Her recovery journey is ongoing, but she has shown remarkable resilience and determination.

“Karla is doing well post-surgery and radiation. She is eager to resume her work and studies,” Dr. Labib stated, praising her spirit. He expressed optimism for Flores’ future, acknowledging her bravery in facing such a daunting health challenge.

Challenges and Resilience

Although recovery has been positive, Flores has experienced some nerve damage due to the tumor’s proximity to her brainstem, which has impacted her left eye’s movement. Despite these challenges, she remains grateful for the successful removal of her tumors.

“Learning about these tumors was terrifying, but I am thankful the doctors were able to address the issues,” Flores recounted. Her aspirations include attending school to learn professional manicuring.

With a focus on the future, UMMC’s surgical team plans to showcase the transorbital technique at the upcoming Skull Base surgery course this fall, imparting knowledge to neurosurgeons worldwide. Dr. Labib expressed excitement over the educational opportunity, stating that the technique offers a broader corridor to reach these tumors, enhancing the chances for complete removal and reducing the risk of cancer recurrence.

Additionally, the UMMC team has other patients lined up to benefit from similar groundbreaking procedures, promising a continued commitment to innovative surgical practices.