This study was conducted to determine the incidence of cerebral injury as detected by postnatal brain scan in monochorionic twins with selective intrauterine growth restriction. Having excluded cases complicated with twin-to-twin transfusion syndrome and one co-twin suffering intrauterine fetal death, a total of 73 monochorionic twin pregnancies divided into absence (group I, n = 46) or presence (group II, n = 27) of selective intrauterine growth restriction. Mild cerebral injury was defined as presenting one of the following abnormal cranial scan findings: intraventricular hemorrhage grade I, grade II, lenticulostiate vasculopathy and/or subependymal pseudocysts, while severe cerebral injury was defined as presenting intraventricular hemorrhage grade III, grade IV, cystic periventricular leukomalacia (PVL) grade II or higher, porencephalic cysts, and/or ventricular dilatation. The incidence of mild cerebral injury was not significantly different between these two groups (eight cases in group I and six cases in group II). Except for one case that later developed a seizure, the majority (13 out of 14) of cases with minor brain scan anomalies were only transient, without significant clinical impact. There was only one case diagnosed with a major brain scan anomaly (periventricular leukomalacia) in group II. One severe brain injury and three neonatal deaths all belonged to group II with abnormal umbilical artery Doppler in the growth restricted twin. In conclusion, the incidence of severe cerebral injury in monochorionic twin pregnancies with selective intrauterine growth restriction was low, at 3.7%.