Fetal brain imaging following laser surgery in twin-to-twin surgery.

Abstract

To describe the incidence and nature of prenatal brain damage following fetoscopic laser selective coagulation (FLSC) of placental vessels for twin-to-twin transfusion syndrome (TTTS). Retrospective observational study. Single center cohort. All consecutive cases referred for TTTS treated by FLSC between 2003 and 2015. After the FLSC, patients were followed weekly by ultrasound. Fetal magnetic resonance imaging (MRI) scans were systematically planned at 30-32 weeks of gestation. Brain damage diagnosed prenatally by ultrasound or MRI. In total, 1023 cases were reviewed. Brain damage was diagnosed prenatally in 22/1023 (2.1%) cases. Diagnosis was performed by ultrasound prior to MRI in 18 (82%) cases. All lesions were within the spectrum of ischaemic haemorrhagic lesions. Postoperative twin anaemia polycythaemia sequence and recurrence of TTTS were significantly associated with brain damage. The incidence of prenatal brain damage is low following FSLC, and is strongly associated with incomplete surgery. Following FSLC for TTTS, prenatal brain damage occurs in 2% of cases and is associated with incomplete surgery.