Imagine curing a life-threatening tumor by going through someone’s eye. That’s exactly what a team of surgeons did for a 19-year-old woman named Karla Flores — and it wasn’t for eye cancer.

They removed a rare spinal tumor by entering through a patient’s eye socket—a route never used before to reach the spine. Remarkably, the patient’s eyesight was not affected.

This is the first of its kind surgery in the world. It lasted nearly 19 hours, and the margin for error was razor-thin. Even a millimeter’s deviation could have left Karla Flores paralyzed from the neck down or caused a fatal brainstem stroke.

This bold and delicate procedure has not only saved Karla’s life but could reshape how doctors treat some of the most difficult-to-reach tumors in the human body. It sheds light on alternative pathways to safely reach and remove tumors hidden deep in the skull and spine without causing any damage to our delicate nervous system.

Why did the doctors go for the eye socket?

Karla Flores was a healthy teenager with big dreams of becoming a manicurist until she started seeing double while learning to drive. She thought it was just a simple eye problem, but it turned out to be something far more serious — a rare type of bone tumor called a chordoma. 

Chordomas are tricky tumors, with a jelly-like texture and hard, calcified parts that make them hard to remove. The tumor was sitting behind her left eye and growing dangerously close to her spinal cord. After the diagnosis, a team of doctors led by Dr. Mohamed Labib, a neurosurgeon at the University of Maryland, decided to perform a craniotomy (a type of brain surgery) to remove the chordoma.

The surgery took 14 hours and was almost successful, but it also brought bad news. Karla had not one but two tumors. The doctors found another tumor wrapped around her upper spine during the procedure. At that time, Labib and his team had no idea how they were going to remove the chordoma in the spine, because, unlike the bone tumor in the brainstem, this one was located in a region that was hard to access.

A week later, an additional 14-hour procedure was conducted through Karla’s nasal passages to remove some remaining tissue of the first tumor. This led to the successful removal of the brain chordoma, but the surgeons were still unsure how they would get rid of the one in the spine. Traditional methods, such as going through the mouth, back of the neck, or nostrils, were too risky or gave poor access to the tumor.

This is where they were left with only one option, i.e., to open up the left eye socket. Surgeries of the eye socket are typically performed to treat medical conditions affecting the orbit, the bony cavity that houses the eye and its nearby structures. These surgeries are not used to access deep tumors in the brain or spine.

After some consideration, Klara was ready to take the chance. However, to make sure such a procedure could work, Labib discussed her case in detail with another experienced plastic surgeon at the hospital. Plus, he and his team spent hours practicing the procedure on cadavers since such a surgery had never been performed.

The process of reaching and removing the tumor

The surgery was conducted on May 1, 2024, and required experts from three different fields working in perfect coordination. First, a plastic surgeon carefully moved aside Karla’s eyeball without damaging her vision. He removed sections of bone from her face and hip, which were later used to rebuild her eye socket.  

Then, a neurosurgeon (Dr. Labib) and a head and neck surgeon used tiny tools to drill into the spine via the eye socket, slowly accessing and removing the tumor without touching the sensitive spinal cord. They also used one of the nostrils to hold the tumor from the other side while they removed it. For nearly 19 hours, the team worked together in complete focus, pausing only briefly for food or water. 

When the tumor was finally gone, the plastic surgeon rebuilt Karla’s facial structures using titanium mesh and screws, making it look like nothing had ever happened. Later, a CT scan confirmed there were no signs of the tumor left. After two days, a small surgery was performed to reinforce the area where the skull meets the spine, using rods, screws, and plates.

After a month, Karla underwent proton therapy, a type of radiation treatment that is used to remove any tumor remains in the body. Now, a year after her surgery, recent scans show no signs of the tumor, and both her brainstem and spine appear healthy. 

“She has some lingering issues with moving her left eye as a result of nerve damage from the tumor abutting the brain stem, but overall, Karla is doing very well. I am happy that through a very coordinated multidisciplinary team effort, she had such a successful outcome. ” Dr. Labib said.

Karla still wears a neck brace to keep her spine aligned, and it will be a while before she can return to her old job. But she’s in no rush—unlike before, she now looks forward to a long, healthy life. She is hopeful that after some years of working and saving money, she’ll finally be able to pursue her dream of running a nail salon.  

“I keep reminding myself to take one day at a time and know that each step is an accomplishment. I’m also glad I stood my ground and kept looking for help until I found it. Things could have gone horribly wrong if I didn’t believe in myself,” Karla said.