In an unprecedented surgery, a rare spinal tumour was extracted through the patient’s eye socket at the University of Maryland Medical Centre.
This novel approach spares major nerves, blood vessels, and other structures in the difficult-to-reach area.
Although surgeons use a transorbital approach to access tumours in the brain and sinuses, this is the first time it has ever been used to remove a spinal tumour.
University of Maryland Medical Centre neurosurgeon Dr Mohamed A.M. Labib explained how surgeons successfully removed the rare bone tumour (a chordoma) from the patient’s cervical spine by threading surgical tools through her eye socket.
The UMMC neurosurgeon and Assistant Professor of Neurosurgery at the University of Maryland School of Medicine (UMSOM) said: ‘The tumour was wrapped around the patient’s spine and spinal cord and had invaded the vertebrae in her neck, just below the base of the skull. By going through the bottom of the eye socket, we were able to remove a tumour that otherwise would have been very difficult and very risky to address.’
Dr Labib said that trying to reach the tumour from the back could have risked damaging the spinal cord.
‘We also avoided disturbing or damaging key structures such as the eustachian tube, major blood vessels such as the jugular vein and internal carotid artery, and nerves that control swallowing and speech. We created a huge surgical corridor that enabled us to get in front of the spinal cord. It was a straight shot.’
The patient, who has no evidence of cancer, required multiple surgeries and received extraordinarily complex care from a multidisciplinary team of physicians that included neurosurgeons, skull base and facial plastic surgeons and radiation oncologists.
In addition to the spinal tumour, she also had a very large chordoma that was wrapped around her brain stem, a critical structure which controls many vital functions. In two separate procedures, UMMC surgeons removed part of the tumour by opening her skull in a traditional craniotomy.
They then removed the rest by accessing the area through her nose. The transorbital and endonasal procedures involved using an endoscope, a thin, lighted tube with a camera at the end.
Dr Labib developed the novel surgical plan to remove the spinal tumour after exploring the transorbital approach in the Department of Neurosurgery’s Skull Base 360° Laboratory using cadavers.
In addition to three surgeries last spring, the patient, Karla Flores, now 20, from Rosedale, MD, was treated with proton radiation therapy to eliminate any lingering cancer cells. A neurosurgeon also fused the C1 and C2 vertebrae in her neck to stabilise her spine.
