A groundbreaking neurosurgical procedure performed at the University of Maryland Medical Center has not only saved a 19-year-old woman’s life but may have ushered in a new standard in skull base surgery. In what specialists are calling an extraordinary case, Karla Flores was diagnosed with two chordomas—an ultra-rare type of malignant bone tumor—after an MRI scan accidentally captured a lower section of her spine than intended.
While most patients with even one chordoma face complex treatment, Flores’ case was complicated further by the second tumor, which may have gone unnoticed without this MRI mistake. What followed was a pioneering surgery, developed from scratch, that left Flores cancer-free and on a path to recovery.
A rare cancer with even rarer circumstances
Flores first sought medical care after experiencing troubling symptoms—specifically, double vision. After initial evaluations, doctors diagnosed her with chordoma, a type of bone cancer that typically forms along the spine or skull base. According to the National Cancer Institute, chordomas affect just one in a million people annually in the United States, or roughly 300 individuals per year.
Flores had been experiencing persistent double vision when she was referred to the University of Maryland Medical Center, where neurosurgeon Dr. Mohammed Labib took on her case. While planning surgery, he ordered an MRI—but the imaging captured a region lower on her spine than intended.
That mistake would prove life-saving. It revealed a second chordoma, located dangerously close to her spinal cord. This second tumor, invisible in earlier scans, may never have been discovered until it was too late.
“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.”
Inventing a surgical first: the “third nostril” approach
Faced with the seemingly impossible task of removing both tumors without harming critical nerves or structures, Dr. Labib and his team developed an entirely novel surgical technique. Dubbed the “third nostril” approach, it involved accessing the tumor through a combination of nasal and facial pathways.
Over several weeks, Labib and his colleagues studied skull models and customized their surgical instruments for the unprecedented procedure.
The complex surgery required a multi-disciplinary team:
- Dr. Kalpesh Vakharia, a facial reconstructive surgeon, made the initial incision through the cheekbone, creating an access point.
- Dr. Andrea Hebert, a head and neck surgeon, approached the tumor from the back by drilling through the vertebrae.
- The tumors were excised using a path that went through the right nostril and the inner side of the left eye socket, following the removal of part of the cheekbone and the eye socket’s membrane.
The entire operation, including facial reconstruction using bone from Flores’ hip, took 20 hours to complete—and left no visible scarring.
For those interested in advanced skull base surgery techniques, the Journal of Neurosurgery provides research on evolving approaches in this field.
From recovery to remission
After the surgical team fully removed both tumors, Flores underwent radiation therapy to ensure complete eradication of the cancer. A year later, follow-up imaging confirmed she is cancer-free. Flores is now working with therapists to regain full movement in her eye and resume a normal life.
“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.
What this means for future patients
Chordomas are notoriously difficult to treat due to their proximity to critical neurological structures and resistance to chemotherapy. Historically, surgical removal has posed extreme risk when tumors are located near the skull base. However, Dr. Labib believes this case could shift that paradigm.
“The third nostril approach,” he explained, “could become the standard procedure for reaching tumors for patients in Flores’s situation.”
In a field where surgical innovation often takes years of clinical testing, this case stands out as a real-time example of adaptation and creative problem-solving in medicine. It also illustrates the essential role of multidisciplinary collaboration—neurosurgery, oncology, radiology, and reconstructive surgery all played vital roles in Flores’ outcome.
For more on this condition and future research, see Chordoma Foundation, which provides up-to-date information and resources for patients and clinicians.
A missed scan that changed everything
Ultimately, a single MRI taken slightly lower than requested led to the discovery that may have saved Flores’ life. Though accidental, it underscores the importance of thorough imaging and relentless medical curiosity in complex diagnoses.
Flores’ story is a reminder that even in medicine, where evidence and protocol dominate, a moment of unintended chance—combined with clinical brilliance—can lead to miraculous outcomes.
Recommended For You
