In what is being hailed as a world-first in neurosurgery, a multidisciplinary medical team, including Indian American facial plastic and reconstructive surgeon Dr. Kalpesh T. Vakharia, has successfully removed a rare cancerous spinal tumor through a patient’s eye socket. The complex and pioneering procedure, carried out at the University of Maryland Medical Center (UMMC), has opened new possibilities for treating tumors in hard-to-reach areas of the body with minimal visible scarring.
The patient, 20-year-old Karla Flores of Rosedale, Maryland, was diagnosed with a slow-growing but potentially life-threatening tumor known as a chordoma. Affecting only about 300 people in the United States each year, chordomas are rare developmental bone tumors that often arise along the spine and can be extremely difficult to remove due to their location and tendency to wrap around critical structures like the spinal cord.
Flores’ tumor was situated in her cervical spine, dangerously close to vital nerves and blood vessels. Traditionally, removing such a tumor would require large incisions, extensive bone removal, and a high risk of complications. However, Dr. Mohamed A.M. Labib, a neurosurgeon and Assistant Professor of Neurosurgery at the University of Maryland School of Medicine (UMSOM), saw an opportunity to adapt a technique used for brain and sinus surgeries — the “transorbital” approach — to access and remove the spinal tumor.
A First-of-its-Kind Approach
The transorbital method involves accessing tumors through the eye socket, or orbit, without removing the eye itself. While it has been successfully used to reach tumors in the skull base and sinuses, this was the first documented case of using it to remove a tumor from the spine.
Dr. Labib’s idea stemmed from years of research in UMSOM’s Skull Base 360° Laboratory, where he explored unconventional surgical routes on cadaver models. In earlier studies, he even referred to the eye socket as “the third nostril,” highlighting its potential as a hidden pathway to deep and delicate anatomical areas.
“This approach allowed us to reach the tumor without creating visible scars or causing unnecessary trauma to surrounding tissue,” said Dr. Labib in the UMMC press release. “It was a chance to push the boundaries of minimally invasive surgery while ensuring patient safety.”
The Surgical Team
To execute such a complex and delicate plan, Dr. Labib assembled a team of specialists. Dr. Kalpesh T. Vakharia, Chief of Facial Plastic and Reconstructive Surgery at UMMC and Director of the Facial Nerve Center, was responsible for the intricate facial incisions and bone modifications that would allow surgical instruments to pass from the eye socket to the cervical spine.
Dr. Andrea M. Hebert, a head and neck surgeon and Associate Professor of Otorhinolaryngology-Head and Neck Surgery at UMSOM, also played a key role in the procedure. Together, the surgeons worked in perfect synchronization to navigate the narrow anatomical corridors while avoiding damage to the patient’s eye, nerves, and vital structures.
Step-by-Step: How the Surgery Was Done
Unlike previous transorbital surgeries that required external incisions near or above the eye, Dr. Vakharia used a different approach to ensure no visible scarring. He began by making a precise incision inside the lower eyelid, cutting through the conjunctiva — the transparent membrane that covers and protects the eye — without disturbing the eye itself.
Simultaneously, a second incision was made inside the patient’s mouth to assist in creating a surgical pathway. Part of the bottom of the eye socket and a portion of the cheekbone were carefully removed to expand the surgical corridor. This allowed the team to pass instruments through the sinus and into the neck region, reaching the cervical spine where the tumor was located.
Once the pathway was established, Dr. Labib drilled through specific vertebrae to access the tumor. Working under high magnification and using specialized microsurgical instruments, he meticulously separated the tumor from the spinal cord and surrounding tissue.
The tumor was removed in multiple stages, and Flores also underwent proton radiation therapy to destroy any remaining cancer cells. In addition, her C1 and C2 vertebrae were surgically fused to stabilize her neck following tumor removal.
Reconstructing the Face and Eye Socket
After the tumor was successfully removed, Dr. Vakharia faced the equally challenging task of reconstructing the areas affected by the surgery. Using a titanium plate, he rebuilt the bottom of the eye socket, ensuring that the patient’s facial structure remained symmetrical and functional. The cheekbone was reconstructed using bone harvested from Flores’ hip, restoring both appearance and strength.
“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,” said Dr. Vakharia. “Being part of a procedure that had never been done before was both humbling and inspiring.”
The Recovery and Outcome
Flores’ recovery involved a combination of post-surgical monitoring, radiation therapy, and physical rehabilitation. Today, she shows no evidence of cancer, and her facial appearance remains unchanged thanks to the careful planning and reconstructive work of the surgical team.
The absence of external scars means that most people would never guess she had undergone such an intricate and life-saving procedure. This outcome stands as a testament to the power of innovation in modern medicine.
Why This Matters for the Future of Surgery
While the transorbital approach is still rare and highly specialized, this case could pave the way for its broader application in treating tumors in complex and hard-to-reach regions. The ability to access deep structures without large incisions reduces patient recovery times, minimizes scarring, and potentially lowers the risk of infection.
Chordomas, in particular, are notoriously challenging to treat due to their location and tendency to recur. This new method provides an additional tool in the surgical arsenal, offering hope to patients with similar conditions.
Moreover, the case highlights the importance of interdisciplinary collaboration in modern healthcare. Neurosurgeons, facial plastic surgeons, head and neck specialists, and reconstructive experts all brought unique skills to the table, working together toward a common goal.
Recognition and Impact
The surgery has attracted attention from the global medical community, not only because it was the first of its kind, but also because it exemplifies the kind of boundary-pushing innovation that can redefine what is possible in surgery. Publications like the Journal of Neurosurgery have already documented preliminary research leading up to the procedure, ensuring that other surgeons can learn from this groundbreaking case.
For Dr. Vakharia, being part of such a historic operation is a career milestone. As an Indian American surgeon with years of expertise in facial reconstruction, his work on this procedure reinforces the critical role of precision and artistry in surgical outcomes.
“This wasn’t just about removing a tumor,” Dr. Vakharia reflected. “It was about giving a young woman her life back, while preserving her appearance and dignity.”
A Personal Triumph for the Patient
For Karla Flores, the experience was life-changing. Facing multiple surgeries, radiation therapy, and the uncertainty of a rare cancer diagnosis, she endured an ordeal that few can imagine. Today, she is living proof that innovation, teamwork, and medical expertise can produce extraordinary results.
She not only survived a tumor in one of the most delicate areas of the body, but she also emerged with her facial features intact and without the scars that might have been a daily reminder of her illness.
Conclusion
This first-of-its-kind surgery — removing a spinal tumor through the eye socket — marks a milestone in neurosurgical history. It showcases how bold ideas, backed by meticulous planning and cutting-edge research, can lead to medical breakthroughs that transform patient care.
The success of Dr. Labib, Dr. Vakharia, Dr. Hebert, and the entire UMMC team stands as an inspiration to the surgical community. More importantly, it offers new hope to patients facing tumors in locations once deemed nearly impossible to reach without disfiguring or debilitating consequences.
As medicine continues to evolve, cases like this remind us that innovation is not only about new technology, but also about new ways of thinking — and the willingness to challenge the limits of what has been done before.
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