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

Abstract

Objective: 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).

Design: Retrospective observational study.

Setting: Single center cohort.

Population: All consecutive cases referred for TTTS treated by FLSC between 2003 and 2015.

Methods: After the FLSC, patients were followed weekly by ultrasound. Fetal magnetic resonance imaging (MRI) scans were systematically planned at 30-32 weeks of gestation.

Main outcome measures: Brain damage diagnosed prenatally by ultrasound or MRI.

Results: 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.

Conclusion: The incidence of prenatal brain damage is low following FSLC, and is strongly associated with incomplete surgery.

Tweetable abstract: Following FSLC for TTTS, prenatal brain damage occurs in 2% of cases and is associated with incomplete surgery.

Keywords: MRI; TAPS; Brain; laser; twin-twin transfusion syndrome.