In a bold step never before attempted, a cadre of surgeons at the University of Maryland Medical Center, helmed by neurosurgeon Dr Mohamed A.M. Labib, dared to chart an unorthodox course—extracting a rare, entwined spinal malignancy from a 19-year-old woman through the thin veil of her eye socket.
While the “transorbital” path has historically been reserved for brain or sinus interventions, this marked its maiden voyage to the spinal terrain. The patient bore a chordoma—an elusive, slow-brewing tumor born from embryonic spinal remnants. Barely 300 such cases surface annually across the United States.
“The tumor had insidiously coiled itself around the spinal cord and clung to the vertebrae just beneath the skull’s cradle,” Dr Labib explained. “Penetrating through the base of the eye, we achieved direct access to a region where conventional routes might’ve sparked neurological disaster.”
Attempting a posterior route would have risked piercing the spinal cord—a perilous gamble. Instead, by sidestepping vital anatomical landmarks like the jugular vein, carotid artery, and nerves pivotal for speech and swallowing, the team carved out a panoramic, unobstructed passage. “It became a surgical superhighway,” Labib described, as per medicalxpress.com.
Karla Flores, the patient at the heart of this medical milestone, endured a tapestry of surgeries involving an ensemble of medical artisans—neurosurgeons, facial architects, radiation specialists, and skull base experts. Beyond the spinal intrusion, Karla also harbored another chordoma wrapping her brainstem, the command hub of countless life-preserving functions.
Surgeons choreographed two additional orchestrations to address the brainstem-ensnaring tumor—first cracking open the cranium in a classic craniotomy, then threading instruments up through the nasal caverns in an “endonasal” ballet, all while employing an endoscope—an optical sentinel guiding their movements.
“This holistic, anatomical-respecting strategy underpins Dr Labib’s signature 360-degree ideology—surgical foresight without sacrificing structure,” remarked Dr Andrea M. Hebert, a seasoned head and neck surgeon who partook in both transorbital and endonasal campaigns.
New reporting on a first of its kind surgery. A team has removed a patient's spinal tumor by going through the eye socket.
— Richard Hanania (@RichardHanania) May 4, 2025
But wait! There's moral ambiguity here.
The lead surgeon is named Mohamed A.M. Labib. He is from Dubai and prays to the Muslim God before surgery. There's… pic.twitter.com/lQYWZ5lA3p
“These tumors, left unchecked, can choke the brainstem—endangering life itself. That’s why aggressive surgical choreography is often our best line of defense,” Dr Hebert added. “They’re notorious for reappearing, so a coalition of specialists is our strongest arsenal.”
The “Third Nostril” and Beyond
The trailblazing technique emerged after Dr Labib, delving into cadaveric blueprints at the Skull Base 360° Lab, theorized that the eye’s orbital socket could serve as a covert gateway to the upper spine. In scholarly musings from October 2023, he dubbed it “the third nostril”—a new portal in the surgical atlas.
Three operations later, paired with targeted proton beam therapy, Karla, now 20, is traversing recovery with fortitude. Her cervical vertebrae (C1 and C2) were fused to buttress her spine, though some lingering visual disturbances remain—a consequence of the tumor’s ominous proximity to the brainstem, according to medicalxpress.com.
Karla reflected on her ordeal, recalling months of mysterious double vision that confounded doctors until an ophthalmologist finally believed her. “When no one seemed to understand, she did. She led me to Dr Labib, who truly listened,” Karla said.
“Facing down diagnoses like there was a storm, but this team stood by me. I’m slowly regaining my life. Every little step matters,” she added, sharing her dream of becoming a manicurist. “I’m glad I never gave up searching for answers.”
Invisible Scars, Unseen Bravery
While traditional transorbital procedures often leave marks near the eyelid, this technique was near-invisible. Partnering with Dr Kalpesh T. Vakharia, a master of facial reconstruction, Dr Labib entered through the eye’s inner membrane and inside the mouth—preserving facial aesthetics entirely, according to medicalxpress.com.
Bone from Karla’s cheek and the floor of the orbit was excised to forge a tunnel to her cervical spine. Once the tumor was meticulously teased out, Dr Vakharia restored the bone using titanium and grafts from Karla’s hip.
“It was artistry in motion,” Vakharia remarked. “To participate in a surgery without precedent—it was humbling.”
Dr Bert W. O’Malley, UMMC’s President and a pioneer himself, lauded the team’s courage. “This wasn’t just about medicine—it was about vision. Instead of falling back on brute force, they crafted a subtler, smarter route for a better outcome. That’s academic medicine at its finest.”
A Symphony of Minds
Chordomas remain an enigma in origin, sprouting from the vestiges of the notochord—a fetal scaffold for the spine. Karla’s case was especially rare: two unlinked tumors in disparate locations.
Dr Labib emphasized that success was communal. “It took a village of minds. No one person could’ve done this alone. The practice runs on cadavers were priceless—we owe this breakthrough to those who gave their bodies to science.”
Dr Timothy J. Chryssikos fortified Karla’s spine post-op with a fusion. Dr Mark V. Mishra, a radiation savant at the Maryland Proton Treatment Center, steered her through precision therapy. Their roles, though quieter, were critical notes in this symphony of survival.
