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).


CONCLUSIONS
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.
Division of Neonatology, Department of Pediatrics, the Department of Biostatistics, and the Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
Marjolijn
M
Spruijt
Sylke
S
Steggerda
Mirjam
M
Rath
Erik
E
van Zwet
Dick
D
Oepkes
Frans
F
Walther
Enrico
E
Lopriore
D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology*; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000601:surgery; D002544:Cerebral Infarction / Q000601:surgery; D003560:Cysts / Q000628:therapy; D004108:Dilatation, Pathologic / Q000601:surgery / Q000628:therapy; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D053685:Laser Therapy / Q000009:adverse effects*; D007969:Leukomalacia, Periventricular / Q000601:surgery; D008297:Male; D011247:Pregnancy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014427:Twins