The aim of this study was to evaluate fetal survival and neonatal outcomes following fetoscopic laser ablation (FLA) for twin-to-twin transfusion syndrome (TTTS). This retrospective study included 106 TTTS pregnancies treated with FLA at Harapan Kita Women and Children Hospital, from January 2016 to January 2025. Maternal and neonatal data were collected from medical records. Fetal survival, gestational age, and neurodevelopmental outcomes were assessed. Quintero staging was used to classify TTTS severity. Statistical analysis used the Mann‒Whitney-U test for continuous variables and the chi square test for categorical variables. Among the 106 pregnancies, 93 (87.73%) had at least one surviving fetus, and 82 (77.35%) had both fetuses that survived the procedure. The highest proportion of double fetal survival was observed in Quintero stage 2 (35/82, 42.68%), whereas double fetal death was most frequently observed in stage 3 (7/13, 53.84%) and stage 4 (4/13, 30.76%) (p = .003). Neonates surviving to 28 days were born at a significantly higher gestational age than nonsurvivors (32.25 ± 2.95 vs. 27.62 ± 2.68 weeks, p < .001; OR 1.70, 95% CI [1.40, 2.10]). The neonatal survival rate at 28 days was 44.87%. Brain injury was observed in 52.17% of the screened infants and long-term neurodevelopmental follow-up was documented in 8 infants, with 2 showing delayed milestones. Quintero stage at the time of the procedure, prematurity, and growth restriction were significantly associated with neonatal survival outcomes. Early detection, timely intervention, and long-term follow-up are essential to optimize outcomes and address potential developmental delays.