Karla Flores was only 18 when he began to experience dual vision. She knew what was wrong, but it was difficult to find a diagnosis. Finally, she saw an ophthalmologist who referred her to a neurosurgeon.

Flores, then 19, was diagnosed with myeloma wrapped around the brain stem. Chudomas is very rare - in the United States, only about 300 diagnosed each year, according to the Cleveland Clinic - they have slow growth, malignant tumors.

Dr. Mohammed Labib, a neurosurgeon at the University of Maryland Medical Center, said the tumor was putting pressure on it. Labib has developed a complex surgical plan that requires two surgeries to remove tumors without damaging the delicate nerves.

When Flores performed an MRI on the morning of his first surgery, the technician placed the camera slightly lower than necessary. When viewing the scan, Labib realized that Flores had a second string tumor. This is the top of her spine, in the front of her spinal cord. Labib said it was wrapped around her spinal cord and invaded the vertebrae on her neck.

"They told me that if they haven't seen it, I might be paralyzed."

Despite the amazing discovery, Rabbib decided to proceed with the procedure to remove Flores' first thorn. The tumor was successfully removed by traditional neurosurgery and another procedure that passed through Flores' nose.

Between the processes, Labib studied the location of the second tumor. In most cases, he would make an incision in the spine to approach the tumor from the back, but the location of the notochord means that it is not an option. Walking through Flores' nose again won't give him enough space to operate. One colleague even suggested that there was nothing they could do.

"I talked to colleagues and one of them said 'You won't heal her from it,' Basically, maybe she should be more like a palliative care patient."

Palliative care is to make terminally ill patients feel comfortable in the last few days. “I’m not enthusiastic about it,” Labib added.

Develop a unique surgical plan

Labib continued to study Flores' scanning and found a way to reach the second ridge. While considering approaching it through his nose, he realized that the che bone between his nose and his eyes was one of the obstacles that prevented him from reaching the tumor. That gave him an idea: What if he walked closer through Flores' eyes?

He had surgery a few years ago but never had a spinal tumor removed. Labib spent weeks practicing the technique, which he called in his neurosurgery lab at UMMC, called it the "third nostril" method. He used the corpse head and skull model to make sure he could reach his hand safely on the tumor. He and the rest of Flores' team spent weeks addressing potential issues, including ensuring they could create surgical openings without damaging the eyeball and modifying surgical instruments so they could work for the procedure.

After he was confident in the approach, Labib told Flores and his family about the program.

"Her mother cried. Kara was excited. Her father, he was not an exciting guy, but he was worried about it from his silence."

Flores said she trusted Rabib and approved the surgery.

“I’m afraid I won’t see my parents again because you never know what happens when you have surgery,” she admitted.

In the operating room, facial plastic and reconstruction surgeon Kalpesh T. Vakharia cut a membrane that protects the eyes inside the lower eyelid and removed the bottom and part of the che bone of Flores' glasses socket. This allows Labib to reach the operating site. This also leaves Flores free of external scars, Vacaria said.

After the bone was removed, Labib and head and neck surgeon Dr. Andrea Hebert drilled into the tumor in Flores' vertebrae. They carefully dissected it according to the procedures they developed in the lab. By the time it was finished, Labib said the spine had been completely removed.

"It's perfect," he said.

After doing this, Vakharia rebuilt Flores' glasses with titanium plates and rebuilds her cheeks with bones on her hips. The process took about 20 hours, Labib said.

“Every step is an achievement”

The spine was removed, but Flores still had more treatments. The spinal surgeon stabilizes the affected vertebrae during the operation. Six weeks later, she received radiation therapy to ensure there was no cancer in her body. Nearly a year after completing treatment, Flores had no evidence of cancer.

Rehabilitation treatment is performed after treatment. Flores, 20, struggled to move his left eye due to nerve damage from a chiropractic tumor, but was still working on physical therapy.

Flores said she wanted to go to school to become a manicurist when she felt better. She has a follow-up date at UMMC every few months. Her biggest struggle now is medical expenses: She says she owes about $600,000. GoFundMe raised only a few thousand dollars.

"I have been reminding myself to spend a day at a time knowing that every step is an achievement. I am also glad I stood up and kept asking for help until I found it."

Labib said he hopes the procedure can be used to help other hard-to-reach tumors.

"I think this opens up a new corridor for tumors that are close to the upper (or high part) of the spine," Labib said. "I think this third nostril approach is a smaller, easier, cleaner approach, and I think it will really take these difficult tumors before the spinal cord."