India’s first open foetal surgery: AIIMS Delhi doctors repair severe spina bifida in womb at 25 weeks
New Delhi: AIIMS Delhi has carried out India’s first open foetal surgery, operating on an unborn baby with a severe spinal defect while the foetus was still in the womb. The six-hour procedure took place on November 12, when the pregnancy was at 25 weeks, and the institute made it public on Saturday.
Doctors repaired a lumbosacral myelomeningocele, the most severe form of spina bifida, to prevent further damage to the developing spinal cord. A team of more than 30 clinicians and nurses worked across several specialities, and the surgery was provided free of cost under a government scheme. Here are the details of the procedure, the evidence behind it, its risks and the prevention message from doctors.
How AIIMS Delhi performed the open foetal surgery
The operation followed more than five weeks of preparation, which covered detailed foetal imaging, counselling, anaesthetic planning and an operative simulation, the hospital said. The mother was first screened and counselled by the maternal-foetal medicine team, with support from radiodiagnosis and other specialists.
The surgery itself took place at the Neurosciences Centre, with high-end microscopy and continuous ultrasound guidance.
Dr Deepak Gupta led the neurosurgical part, while Dr Neena Malhotra and Dr K Aparna Sharma headed the maternal-foetal medicine and obstetric teams. Specialists from obstetrics and gynaecology, neurosurgery, plastic surgery, neonatology, radiodiagnosis, maternal-foetal medicine and both obstetric and neuroanaesthesia took part.
What is myelomeningocele
Myelomeningocele is an open neural tube defect, in which the spinal cord and its coverings push out through an opening in the spine. Children born with it can develop paralysis, hydrocephalus and other neurological disabilities that last a lifetime.
Speaking on what the surgery means for the country, Dr Gupta, President of the Indian Society for Pediatric Neurosurgery, said, “This establishes an important new capability for fetal care and paediatric neurosurgery in India.”
He also explained the purpose of the surgery and its limits, saying, “In rigorously selected cases, prenatal repair seeks to limit ongoing injury to exposed neural tissue, reduce the subsequent need for cerebrospinal-fluid diversion for hydrocephalus, and improve selected neurological outcomes. It is not a cure, and long-term multidisciplinary care remains essential.”
MOMS trial: Evidence for prenatal spina bifida repair
International research backs prenatal repair in carefully chosen cases. The Management of Myelomeningocele (MOMS) trial found that 40 per cent of children operated on before birth needed a cerebrospinal-fluid shunt by 12 months, compared with 82 per cent of those repaired after birth. Surgery before birth was also linked to better motor outcomes and less Chiari II hindbrain herniation.
Risks of foetal surgery
The procedure is not without danger. Foetal surgery can lead to prematurity and to complications related to the uterine scar, which is why it is advised only at specialised centres and in carefully selected pregnancies. Dr Sharma stressed the care this requires, saying, “The safety of both mother and fetus depends on detailed counselling, high-quality anaesthesia, and coordinated surveillance before and after surgery.”
The mother and the foetus will remain under close multidisciplinary monitoring for the rest of the pregnancy, during delivery and through the newborn period, the hospital said.
AIIMS described the surgery as the result of its long effort to build foetal spinal surgery capability. In the hospital’s words, “Fourteen years ago, we spoke of the possibility of foetal spinal surgery at AIIMS. Today, that possibility has become a reality. Our next responsibility is to make it safe and accessible to the Indian families who may benefit from it.”
Preventing neural tube defects
Doctors made it clear that foetal surgery is a treatment for selected pregnancies and cannot take the place of prevention. The neural tube closes about 28 days after conception, often before a woman realises she is pregnant. Counselling on folic acid before conception, evidence-based folate fortification and stronger national surveillance are therefore key to reducing the burden of these defects, the hospital said.
(With inputs from PTI)