New Delhi: Country’s premier medical institution AIIMS is contemplating to start antenatal (before birth) surgeries. Brain tumours, spinal injuries and spinal diseases are few common problems which develop during foetal stage. In most of the cases, woman either gives birth to babies with deformity or has to undergo an abortion. In order to address such neurological disorders in children, AIIMS is planning to come out with surgeries which are possible before birth.

Dr Deepak Gupta, Associate Professor of Neurosurgery in AIIMS discussed the unusual case of Tanmay Sharma who has never moved his legs since birth. The two-year-old boy has small boil on his back. Tanmay has been suffering from a problem called spinal dysraphism or myelomeningocel. The condition affects nearly one or two of every 1,000 children globally.

He also said, “Once the baby is born, we operate to remove the bulge and give some comfort to the patients. But the paralysis cannot be reversed. Antenatal surgeries have much better results. We are now considering starting this procedure in AIIMS.”  

Dr B S Sharma, the Head of Neurosurgery in AIIMS, said. “Antenatal surgeries require super speciality laboratories. We will need a collaborative set up with the Department of Paediatrics and Gynaecology. It will require long planning, but we are working on it.”

While explaining the criticality of the issue, he said that the condition is attributed to problems at the foetal stage, when the brain and the spinal cord are developing during the first 28 weeks of pregnancy.

If the tissue at the bottom of the spinal cord or the skull fails to close properly during this time, baby’s brain or spinal matter can bulge out. The problem should ideally be detected through ultrasound during pregnancy.

“If it is detected at 20 weeks or less during pregnancy and surgeries can be done at 32 weeks or less, the outcome is excellent according to existing global evidence,” Dr Gupta said.

Explaining how it is done, the doctors said the foetus is taken out of the uterus and operated on to remove the bulging matter. After the procedure, surgeons put the foetus back in the womb.

“Since the tissues don’t develop at this stage, the intervention is timely and the outcome is better,” Dr Sharma said.

Though it can be detected by ultrasound, two scans performed at five and eight months of pregnancy failed to identify the problem in Tanmay. As a result, postnatal surgery can remove the bulge on his back, but there is little hope that he will be able to move his legs.

Doctors said many medical practitioners were not aware and, hence, the problem goes undetected during ultrasound scans.

On November 1, neurosurgeons in AIIMS discussed such problems and other child neurological problems during public talk event.

A 2011 report in the New England Journal of Medicine says foetal surgeries to treat spinal dysraphism or myelomeningocel offered greater chances of restoring nerve function and a higher possibility of the affected children walking again.


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