Just before the medical staff wheeled Karla Flores into the operating room for the third time in less than a month, the 19-year-old aspiring manicurist bid farewell to her parents. Uncertain if she would see them again, Karla faced another daunting surgery. Earlier procedures at the University of Maryland Medical Center had already tested her resilience, including two grueling 14-hour surgeries aimed at removing a rare bone tumor the size of a chicken’s egg from her brain. This time, however, the challenge was even greater. A second, smaller chordoma was constricting her spinal cord near the base of her skull, presenting a life-threatening situation.
After extensive deliberation, the medical team opted for an unprecedented surgical approach: they would attempt to remove the spinal tumor through Karla's left eye socket. This innovative technique, if executed correctly, could potentially revolutionize how surgeons tackle difficult-to-reach tumors globally. However, if the surgical path deviated by just a few millimeters, the consequences could be dire, including the possibility of paralysis or a fatal brain-stem stroke.
Meanwhile, Dr. Mohamed A.M. Labib, Karla's lead surgeon and a 46-year-old neurosurgeon, took a moment to pray in the hospital chapel before the operation. “I am only a tool in the hands of God,” Labib reassured his patients, a belief that instills comfort in him as he navigates the complexities of neurosurgery. With roots in Dubai and a journey that brought him to Canada at 17, Labib has adopted a pioneering ethos inspired by legendary neurosurgeon Robert Spetzler, urging him to “accept challenges” and “reject norms.”
Karla, who enjoyed horror movies and the Call of Duty video game series, had been in good health for most of her life. However, in 2023, while learning to drive, she began experiencing troubling symptoms. Double vision prompted her to see an eye doctor, where scans revealed a large mass pressing against her left eye—a malignant chordoma. This rare tumor, diagnosed in about 300 individuals each year in the United States, can vary in texture and poses significant health risks.
Upon receiving a referral, Karla met with Dr. Labib, who explained that two surgeries would be necessary to remove the brain tumor. He would perform the first surgery alone and the second in partnership with Dr. Andrea Hebert, a head and neck surgeon. Despite the gravity of her situation, Karla maintained a remarkable composure, soothing her parents who struggled with English as she explained the medical procedures.
The first surgery on April 16, 2024, involved removing a palm-sized piece of Karla's skull to access the tumor. Although the surgery was successful, it revealed the presence of a second chordoma, a thumb-sized mass in her cervical spinal cord. Dr. Labib warned that aggressive treatment was essential, as the spinal chordoma could grow rapidly, increasing the risk of paralysis or death.
Faced with various treatment options, including radiation and surgical approaches through the neck or mouth, the medical team ultimately decided to employ a novel technique suggested by Labib in a research paper: accessing the tumor through the lower eye socket, which he referred to as “the third nostril.” This path had never been attempted on a living patient, but Labib was confident in its potential.
Before presenting the plan to Karla, Labib consulted with Dr. Kalpesh Vakharia, a facial plastic and reconstructive surgeon. After careful consideration, they agreed that the eye socket provided the best chance of success despite the inherent risks. Labib explained the procedure to Karla, ensuring she understood the groundbreaking nature of the surgery. Although nervous about being the first patient to undergo this method, Karla placed her trust in Labib and decided to proceed.
Just eight days after the first surgery, Karla underwent a second operation to remove the remaining brain tumor through her nostrils. After this procedure, she had just a week to mentally prepare for the upcoming surgery through her eye socket.
On May 1, 2024, the day of the surgery, Labib was hyperalert, fueled by his usual three shots of espresso. The atmosphere in the hospital was tense yet filled with determination. As Karla and her family drove to the hospital, they remained quiet, each grappling with their thoughts and concerns.
Entering the operating room at 8 a.m., Karla was put under anesthesia. With a team of six medical professionals, Vakharia carefully made incisions to shift Karla's eyeball and surrounding tissues, ensuring no pressure was applied during the procedure. The operating room was silent except for the sounds of medical equipment, with Labib and Hebert meticulously working to navigate their way to the tumor.
After nearly 19 hours of continuous surgery, the team successfully removed the tumor. The operation concluded at 2:50 a.m., and Karla was taken for a CT scan to verify that the tumor was completely excised. Two days later, she underwent another minor surgery to stabilize the junction between her skull and cervical spine.
After a month and a half of recovery—first in rehabilitation and then at home—Karla began proton therapy to eliminate any remaining tumor fragments. Almost a year after her surgeries, she reported that her neck still ached, and she wears a bone therapy collar for support. Fortunately, her recent scans showed no signs of cancer recurrence, and Dr. Labib expressed optimism regarding her prognosis.
Despite the successful outcomes, Karla's health insurance did not cover the nearly $600,000 cost of her innovative surgery. Eager to return to her previous job at Kohl's and save for nail school, she dreams of running her own nail salon one day. Karla, who enjoys painting her nails and those of her mother, looks forward to a bright future ahead, hoping to bring joy to others through her craft.
