Prevalence and risk factors of cerebral lesions in neonates after laser surgery for twin-twin transfusion syndrome

Am J Obstet Gynecol. 2012 Oct;207(4):320.e1-6. doi: 10.1016/j.ajog.2012.06.031.


Objective: To identify risk factors for cerebral lesions among survivors of twin-twin transfusion syndrome treated with laser surgery.

Study design: A multilevel regression analysis examined risk factors for neonatal cerebral lesions identified by imaging. Imaging was routine in "high-risk survivors," defined as those delivered at <32 weeks' gestation, and by clinical indications if born later. Severe lesions were defined as: intraventricular hemorrhage grade III-IV, cystic periventricular leukomalacia, ventriculomegaly and/or hydrocephalus, microcephaly, infarctions, porencephalic/Dandy-Walker cysts, or bilateral other cysts.

Results: For 262 consecutive laser-treated twin-twin transfusion syndrome patients, 18 neonates had severe lesions identified among 427 individual survivors (4.2%) and 242 "high-risk survivors" (7.4%). Forty-six newborns had any cerebral lesion, resulting in lesion rates of 10.8%-19.0%. Delivery <32 weeks' (odds ratio, 4.95; P < .001) and <28 weeks' (odds ratio, 6.25; P < .001) gestation were associated with increased likelihood of any cerebral lesion.

Conclusion: This cohort showed low rates (4-7%) of severe neonatal cerebral lesions, with prematurity being the primary risk factor.

MeSH terms

  • Female
  • Fetofetal Transfusion / surgery*
  • Fetoscopy / adverse effects
  • Humans
  • Hydrocephalus / epidemiology
  • Hydrocephalus / etiology*
  • Infant, Newborn
  • Infant, Premature
  • Intracranial Hemorrhages / epidemiology
  • Intracranial Hemorrhages / etiology*
  • Laser Therapy / adverse effects*
  • Leukomalacia, Periventricular / epidemiology
  • Leukomalacia, Periventricular / etiology*
  • Pregnancy
  • Prevalence
  • Risk Factors