Surgeons remove spinal tumor through eye socket in unprecedented procedure

Editor's Note

In a world-first procedure, surgeons used an innovative “transorbital” approach to access a cancerous chordoma wrapped around the cervical vertebrae and spinal cord of a 19-year-old woman, bypassing structures that would have been endangered by a more traditional surgical route. Medical Xpress reported the news May 5. 

As detailed in the article, the patient, Karla Flores, had two separate chordomas—exceedingly rare, slow-growing developmental bone tumors—one surrounding her brain stem and the other infiltrating her upper spine. A team led by Dr. Mohamed Labib, a neurosurgeon at University of Maryland Medical Center (UMMC), devised a novel plan to reach the spinal tumor through the orbit using an endoscope. Dr. Labib described it as “a straight shot” to the tumor with significantly reduced surgical risk, avoiding critical structures such as the jugular vein and nerves controlling speech and swallowing.

Surgeons removed the brainstem-wrapped chordoma in two other procedures: one via traditional craniotomy and another through an endonasal route. All three operations relied on minimally invasive endoscopic techniques. According to Medical Xpress, the transorbital pathway was created by making incisions inside the patient’s lower eyelid and mouth, removing part of the eye socket and cheekbone to reach the vertebrae. The approach left no visible scars. Dr. Kalpesh Vakharia, a facial plastic surgeon, reconstructed the patient’s eye socket and cheek using a titanium plate and bone graft.

Flores underwent spinal fusion surgery to stabilize her neck and proton radiation therapy to target remaining cancer cells, the outlet reports. She is currently cancer-free and recovering well, despite some residual eye movement issues due to nerve damage.  

The team’s approach drew on anatomical research conducted in UMMC’s Skull Base 360° Lab, where surgeons had practiced transorbital access to the skull base in cadavers, Medical Xpress reports. Dr. Labib referred to the orbit as “the third nostril,” referencing earlier research he published in the Journal of Neurosurgery. He emphasized that having access to cadavers for practicing rare procedures was vital to achieving such a complex outcome, crediting the multidisciplinary team and research infrastructure for the patient’s successful result.