AIIMS-Delhi performs India’s first open foetal surgery to repair severe spinal defect

In a medical first for India, AIIMS, Delhi has successfully performed an open foetal surgery to repair a severe spinal defect in an unborn baby at 25 weeks’ gestation, aiming to prevent further damage to the developing spinal cord, the premier institute said on Saturday.

The six-hour procedure, performed on November 12, involved repairing a lumbosacral myelomeningocele, the most severe form of spina bifida, while the foetus was still in the womb, it said.

The surgery was performed after more than five weeks of multidisciplinary planning, detailed foetal imaging, counselling, anaesthetic preparation and operative simulation, the hospital said.

The neurosurgical component was led by Dr Deepak Gupta, while the maternal-foetal medicine and obstetric teams were led by Dr Neena Malhotra and Dr K Aparna Sharma.

More than 30 clinicians and nurses from obstetrics and gynaecology, maternal-foetal medicine, neurosurgery, obstetric and neuroanaesthesia, plastic surgery, radiodiagnosis and neonatology participated in the procedure.

The multidisciplinary surgery was carried out at the Neurosciences Centre using high-end microscopy and continuous ultrasonography assistance.

“This establishes an important new capability for fetal care and paediatric neurosurgery in India,” Dr Gupta, President of the Indian Society for Pediatric Neurosurgery, said.

“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,” he said.

Myelomeningocele is an open neural tube defect in which the spinal cord and its coverings protrude through an opening in the spine. Children affected by the condition can develop paralysis, hydrocephalus and other lifelong neurological disabilities.

International evidence supports prenatal repair in carefully selected cases. The Management of Myelomeningocele (MOMS) trial found that 40 per cent of children who underwent prenatal repair required cerebrospinal-fluid shunt placement by 12 months, compared with 82 per cent after postnatal repair.

Prenatal surgery was also associated with improved motor outcomes and reduced Chiari II hindbrain herniation.

However, foetal surgery carries significant risks, including prematurity and complications related to the uterine scar, and is recommended only in specialised centres and carefully selected pregnancies.

“The safety of both mother and fetus depends on detailed counselling, high-quality anaesthesia, and coordinated surveillance before and after surgery,” Sharma said.

The mother and foetus will continue to undergo close multidisciplinary monitoring through the remainder of pregnancy, delivery and the newborn period, the hospital said.

The procedure was provided free of cost under the government’s Janani Shishu Suraksha Karyakram (JSSK), it said.

AIIMS said the mother was initially screened and counselled by the maternal-foetal medicine team, with support from radiodiagnosis and other specialists. The preoperative planning included detailed fetal imaging and operative simulation.

The institute said the procedure marked the culmination of efforts to develop foetal spinal surgery capability at AIIMS.

“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,” the hospital said.

The doctors, however, emphasised that foetal surgery is a treatment for selected pregnancies and not a substitute for prevention of neural tube defects.

Neural tube closure occurs around 28 days after conception, often before a woman knows she is pregnant.

Preconception folic-acid counselling, evidence-based folate fortification and stronger national surveillance are therefore important measures to reduce the burden of such defects, the hospital said.