Struck by one of the rarest cancer diagnoses possible, a young woman has recovered from a never-before-performed surgery and radiation therapy to come out disease free.
Diagnosed with two bone tumors, the hospital only found the second one because somebody performed an MRI scan at a spot that was lower on her spine than they were supposed to.
The story begins when Karla Flores, 19, began to experience double vision. The diagnosis was a chordoma, a bone tumor that afflicts the spinal column diagnosed only 300 times a year in a country of 330 million people.
Referred to the University of Maryland Medical Center’s department of neurosurgery, Flores was told by the doctor set to lead the effort to remove the chordoma that the malignant tumor was pressing on the cranial nerve, which was causing the double vision.
While planning for the surgery, Dr. Mohammed Labib ordered an MRI to ensure he had the best view of his quarry, only to discover that Flores had a second chordoma wrapped around her vertebrae from the front of her spinal cord. For determining the chances of such a thing occurring, one’s imagination is perhaps the only source.
For the first chordoma, Labib developed a complex surgical plan to remove the tumor with two surgeries that wouldn’t damage the delicate nerves, but as far as second one, the surgery team was left scratching their heads.
“I spoke to colleagues, and one of them said ‘You’re not gonna cure her from this,’ basically, maybe she should be more of a palliative care patient,” Dr. Labib told CBS News. “I wasn’t very enthusiastic about that.”
The following account of the surgery contains descriptions of human anatomy which some readers may find gruesome, but there’s a happy ending.
Dr. Labib’s eventual plan was nicknamed the “third nostril” approach, and it would involve accessing the tumor, which sat right at the top of the spine under the skull, through both the right nostril and the nose-side periphery of the left eye following the removal of a piece her cheekbone and eye socket membrane.
Weeks were spent studying and practicing on skull models while Dr. Labib’s surgical tools were modified for the approach.
It began when facial reconstructive surgeon Dr. Kalpesh Vakharia cut through the cheekbone, allowing Dr. Labib to reach the tumor site, which head and neck surgeon Dr. Andrea Hebert approached from behind via drilling through the vertebrae.
JAW-DROPPING SURGICAL SUCCESSES:
Including the replacement of the facial components, which utilized bone from Flores’ hip, and left no external scarring, the surgery took 20 hours to complete. When it was finished the tumor had been completely removed.
A spinal surgeon stabilized the affected vertebrae, radiation therapy confirmed Flores to be cancer free one year later, and therapists are helping her recover the movement in her eye.
“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,” Flores said in an emailed statement.
Dr. Labib believes the third nostril approach could become standard procedure for reaching tumors in the general area as Flores’.
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