Fetal brain imaging following laser surgery in twin-to-twin surgery
J Stirnemann1,2,3,4, G Chalouhi1,2,3,4, M Essaoui1,2,3,4
1Department of Obstetrics and Gynaecology, Université Paris Descartes, Paris Sorbonne-Cité, Paris, France.
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.
