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

Abstract

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

Outcome reporting across randomized trials and observational studies evaluating treatments for twin–twin transfusion syndrome: systematic review

“…Two hundred and thirty studies were therefore deemed eligible after full‐text review. From these, all randomized trials ( n = 6) and the largest observational studies ( n = 94) were selected for analysis (Figure ). There were 13 case–control studies, 32 prospective cohort studies and 49 retrospective cohort studies.…”

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

“…• Twin-twin transfusion syndrome (TTTS) is caused by intertwin shifts of blood through placental anastomoses in monochorionic twin pregnancies • Fetoscopic laser surgery is the primary treatment for TTTS and has improved with the development of new techniques over the past decades • The Solomon technique aims to separate the twins' circulations completely and has been shown to decrease the incidence of postlaser twin anemia-polycythemia sequence (TAPS) and recurrence of TTTS • Brain injury and long-term neurodevelopmental impairment remain major concerns after TTTS, but fortunately the incidences of both have decreased significantly over time • Centralization in high output fetal therapy centers is crucial to guarantee the best quality of care in rare diseases needing highly specialized interventions like TTTS and laser surgery [40,41]. Residual anastomoses can cause post-laser TAPS or recurrence of TTTS and these complications are linked to adverse fetal, neonatal and long-term outcomes [42,43]. To minimize the risk of residual anastomoses, a new laser technique was developed, designed to coagulate the entire vascular equator.…”

“…Various reasons have been suggested to explain the decrease in brain injury, including improvement in laser technique and a learning curve effect, both associated with a decrease in residual anastomoses. In a large cohort of 1023 TTTS pregnancies, postoperative TAPS and recurrence of TTTS after laser, both known to be caused by residual anastomoses, were associated with an increased risk of cerebral injury [16,42].…”

“…Fetal and neonatal MRI studies have shed more light on brain abnormalities detected in TTTS in the last decade. Several studies have reported additional findings of MRI compared to ultrasonography alone, including polymicrogyria and other migrational disorders, sinovenous thrombosis, and more subtle and/or diffuse white matter injury [42,64,[68][69][70][71]. Donors and recipients are equally affected by cerebral injury, although the occurrence of cerebral arterial stroke seems to be a specific risk for recipients [42,62,72].…”

Evaluation of long-term neurodevelopment in twin-twin transfusion syndrome after laser therapy

“…To be noted at last that in our series, we report five cases of termination of pregnancy in cases of high risk of neurological impairment (brain lesions diagnosed by fetal MRI and/or demise of the co‐twin). According to a recent study, prenatal brain damage after laser for TTTS, as assessed by third trimester‐MRI, occurs in 2% of cases and is associated with incomplete surgery …”