AIIMS Delhi performs India's first open fetal repair for spina bifida

AIIMS Delhi performs India's first open fetal repair for myelomeningocele

New Delhi, November 14

The six-hour operation repaired the cerebrospinal-fluid-leaking lumbosacral defect in utero. It followed more than five weeks of meticulous multidisciplinary planning, detailed fetal imaging, non-directive counselling, anaesthetic preparation and operative simulation.

The neurosurgical component was led by Professor Deepak Gupta; the Maternal-Fetal Medicine and Obstetric component by Professor Neena Malhotra and Professor K Aparna Sharma; the obstetric anaesthesia and neuroanaesthesia teams by Prof Vimi Rewari, Prof Mihir Pandia, Dr Rashmi Ramachandran and Dr Gyanendra Pal Singh; the plastic surgery team by Dr Shashank Chauhan; and the neonatology team of Dr Ramesh Agarwal and Dr Deepika Kainth.

The patient was screened and counselled first by Prof K Aparna Sharma from the Maternal-Fetal Medicine team along with Dr Anubhuti Rana, Dr Deepali Garg and Dr Saloni Kamboj. The preoperative planning was ably supported by Dr Smita Manchanda from the Department of Radiodiagnosis and Interventional Radiology. The multidisciplinary procedure was performed using high-end microscopy and continuous high-end ultrasonography assistance at the Neurosciences Centre, AIIMS New Delhi.

More than 30 clinicians and nurses from Obstetrics and Gynaecology, Maternal-Fetal Medicine, Neurosurgery, Obstetric and neuroanaesthesia, Plastic Surgery, Radiodiagnosis, Neonatology, and the nursing teams of the Neurosciences Centre and Obstetrics-Gynaecology services participated in the procedure.

Myelomeningocele is an open neural tube defect in which the spinal cord and its coverings protrude through an opening in the spine. India bears a substantial, though geographically variable, burden of neural tube defects. A 2024 systematic review of 27 Indian studies estimated their pooled prevalence at 9.46 per 1,000 births, while highlighting the need for stronger national surveillance.

Professor Deepak Gupta, President of the Indian Society for Pediatric Neurosurgery, said: "This establishes an important new capability for fetal care and paediatric neurosurgery in India. 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."

Professor Neena Malhotra mentioned that "This accomplishment reflects the collective commitment of an exceptional multidisciplinary team."

Professor Aparna Sharma added, "Fetal intervention in this case is a very well-reasoned and planned decision to optimise the outcomes of both the baby and the mother. The safety of both mother and fetus depends on detailed counselling, high-quality anaesthesia, and coordinated surveillance before and after surgery."

The procedure was provided free of cost to the family under the Government of India's Janani Shishu Suraksha Karyakram (JSSK). Comparable combined maternal and infant care in the United States, including fetal surgery, high-risk obstetric care, delivery and neonatal treatment, can exceed ₹1 crore, depending on the institution and clinical course.

The team emphasised that fetal surgery is a treatment for selected pregnancies, not a substitute for prevention. Neural-tube closure occurs by around 28 days after conception, often before pregnancy is recognised. Preconception folic acid counselling, evidence-based food fortification with folates, and robust national surveillance remain essential to reducing India's burden of neural tube defects.

The mother and fetus will continue to receive close multidisciplinary surveillance through pregnancy, delivery and the newborn period. This achievement confirms that AIIMS New Delhi now has the integrated expertise required to assess and offer fetal myelomeningocele repair to appropriately selected Indian families.

A child with spina bifida may begin life with paralysis, hydrocephalus and lifelong challenges. Traditionally, neurosurgeons operate after the child is born. But by then, some of the neurological damage may already have occurred. For some children with spina bifida, the opportunity to protect the spinal cord begins before birth. "Fourteen years ago, we spoke of the possibility of fetal 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."

— ANI