The third nostril: Team led by Canadian-trained neurosurgeon removes spinal tumour through eye socket for the first time

A surgical team at the University of Maryland Medical Center UMMC in Baltimore has successfully removed a rare spinal tumour through the patient’s eye socket.The doctors say this transorbital surgery is the first of its kind to be used to remove a spinal tumour. The patient, 19-year-old Karla Flores, had the tumour wrapped around her spine and spinal cord, just below the base of her 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,” said Dr. Mohamed A.M. Labib, a Canadian-trained UMMC neurosurgeon and assistant professor of neurosurgery at the University of Maryland School of Medicine, said in a news release.The Dubai-born neurosurgeon had completed medical school at McGill, a residency at Western University in London, Ont. and a fellowship at the University of Ottawa before moving to the States. He had developed the surgical techniques that were used to access hard-to-reach skull base tumours through the patient’s eye socket, which he called “the third nostril” in his research.Flores said the symptoms of the tumour started when she was 18 and began to experience double vision. “For a while, I didn’t know what was happening to my health. It felt like no one understood or even believed that there was a physical reason for my symptoms. Then I saw my ophthalmologist who gave me hope because she believed that something was wrong and referred me to Dr. Labib,” she said in the news release. “These tumours are definitely life-threatening when they grow to the point where they cause significant brain stem compression, so surgery is the best way to try to save a patient’s life,” head and neck surgeon Dr. Andrea M. Hebert said in the news release. “Many of these tumours recur, and that’s why we favor a multidisciplinary approach to treatment.”This whole procedure was also done without disturbing the eye and leaving no external scars. Facial and plastic reconstructive surgeon Dr. Kalpesh T. Vakharia made careful cuts through the conjunctiva inside the lower eye and an incision inside the patient’s mouth. She also removed the bottom of the eye socket and a portion of the cheek bone to crease a pathway large enough for Dr. Labib to drill through the bone in the vertebrae and access the tumour.“We created a huge surgical corridor that enabled us to get in front of the spinal cord. It was a straight shot,” said Dr. Labib.Attempting to reach the tumour through the back could have risked damaging the spinal cord, the eustachian tube, major blood vessels and speech nerves.“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,” Dr. Labib said.After that, Dr. Vakharia was able to rebuild the bottom of the eye socket with a titanium plate and used bone from Flores’ hip to rebuild the cheek. Flores said believing in herself and standing her ground helped her get through the process and get the treatment she needed.“I was so relieved when I met Dr. Labib and the team at the University of Maryland Medical Center. They listened and took me seriously. Learning about the spinal and brain tumours was terrifying, but I am so grateful that the doctors were able to remove them. I’m slowly recovering and with any problem I have, they help me,” she said.“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.”

The third nostril: Team led by Canadian-trained neurosurgeon removes spinal tumour through eye socket for the first time

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