Innovative Surgery Removes Rare Spinal Tumor via Eye Socket

In an unprecedented medical achievement, a surgical team at the University of Maryland Medical Center (UMMC) successfully extracted a rare and complex spinal tumor through a highly specialized approach involving the patient's eye socket, or orbit. The patient, a 19-year-old woman, was diagnosed with a slow-growing bone tumor known as a chordoma, which had invaded her cervical spine and was pressing on her spinal cord. This approach marks the first time a transorbital technique has been used to access and remove a spinal tumor.

Traditionally, accessing such tumors involves invasive procedures that risk damaging critical structures. However, the neurosurgery team, led by Dr. Mohamed A.M. Labib, employed a novel approach by creating a surgical corridor through the bottom of the patient's eye socket, which the lead neurosurgeon referred to as "the third nostril." This method allowed direct access to the tumor that was wrapped around the spine and the spinal cord, invading vertebrae just below the skull base.

By navigating through the orbit, surgeons avoided the risks associated with traditional posterior or anterior approaches, such as damaging the spinal cord, blood vessels, or nerves responsible for vital functions. The procedure was performed using endoscopic tools, combining innovative techniques from skull base and facial plastic surgery to remove the tumor safely. The approach included collaboration among neurosurgeons, facial reconstructive surgeons, and radiation oncologists, ensuring comprehensive care.

Following the successful removal, the patient underwent proton radiation therapy to eliminate any remaining cancer cells. The surgical team also stabilized her spine by fusing the C1 and C2 vertebrae. Despite some residual nerve damage affecting her left eye movement, the patient, now 20 years old, reported a positive outcome and expressed gratitude for the multidisciplinary effort.

This groundbreaking procedure was meticulously planned and practiced on cadavers beforehand, highlighting the importance of surgical innovation and collaboration. The use of the transorbital route not only minimized external scarring but also provided a direct pathway to the tumor, avoiding more invasive traditional approaches.

The surgery's success underscores the significance of a multidisciplinary team in managing complex tumors, including neurosurgeons, skull base surgeons, reconstructive specialists, and radiation oncologists. It also demonstrates the potential for expanding minimally invasive techniques to treat tumors previously deemed inoperable through conventional routes.

The case exemplifies how innovative approaches in skull base surgery can significantly impact patient outcomes, preserve quality of life, and advance the field of neurosurgery. The research and techniques employed in this procedure are documented in the October 2023 issue of the Journal of Neurosurgery.