Cerebral Injury in Twin-Twin Transfusion Syndrome Treated With Fetoscopic Laser Surgery

OBJECTIVE: To estimate the incidence and risk factors for cerebral lesions in monochorionic twins with twin-twin transfusion syndrome treated with fetoscopic laser surgery compared with dichorionic twins. METHODS: We performed a case-control study on cerebral injury detected by postnatal cranial ultrasonography in monochorionic twin neonates with twin-twin transfusion syndrome treated with a laser compared with a control group of dichorionic twin neonates matched for gestational age at birth. Severe cerebral lesions were defined as the presence of at least one of the following: intraventricular hemorrhage grade III, periventricular hemorrhagic infarction, periventricular leukomalacia grade II or greater, porencephalic cysts, arterial stroke, ventricular dilatation, or a combination of these. RESULTS: From 2004 until 2011, 267 twin neonates with twin-twin transfusion syndrome could be included and matched with 267 dichorionic twin neonates. Incidence of severe cerebral lesions in the twin-twin transfusion syndrome group and control group was 8.6% (23 of 267) and 6.7% (18 of 267), respectively (P=.44). Multivariable analysis revealed that only gestational age at birth was independently associated with increased risk for severe cerebral lesions (odds ratio [OR] 1.35 for each week, 95% confidence interval [CI] 1.14-1.59, P<.01). In 52.2% (12 of 23), the cerebral lesions in the twin-twin transfusion syndrome group were of antenatal origin compared with 16.7% (3 of 18) in the control group (OR 8.00, 95% CI 1.42-45.06, P=.02). CONCLUSION: Incidence of severe cerebral lesions in twin-twin transfusion syndrome treated with laser is similar to a matched control group and is independently associated with prematurity. In contrast to dichorionic twins, cerebral injury in twins with twin-twin transfusion syndrome most often occurs antenatally. (Obstet Gynecol 2012; 120: 15-20) DOI:10.1097/AOG.0b013e31825b9841 LEVEL OF EVIDENCE: II