Issa Mohammed, Dannehl Clara, Seitz Angelika, Lenga Pavlina, Syrbe Steffen, Krieg Sandro M, El Damaty Ahmed
Faculty of Medicine, Heidelberg University, Heidelberg, Germany.
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Neurosurg Rev. 2025 Jan 10;48(1):33. doi: 10.1007/s10143-025-03190-0.
Postoperative fever following neuroendoscopic procedures has been well-documented, yet specific differentiation based on the nature and site of the procedure remains lacking. Given the anatomical involvement of the hypothalamus in temperature regulation, we propose that endoscopic third ventriculostomy (ETV) may have a distinct impact on postoperative fever. This study aims to investigate this phenomenon. This retrospective comparative analysis includes all patients who underwent neuroendoscopic procedures between January 2017 and September 2023. Patients were divided into ETV and non-ETV groups, and comparisons were made regarding postoperative body temperature during the initial 7 days after surgery. Comprehensive data were collected on case numbers, surgical duration, symptoms, treatments, and outcomes. Body temperature was measured postoperatively in the morning and evening for 7 days, with elevated temperature categorized as sub-fever (37.5 to 38.2 °C) and fever (≥ 38.3 °C). 207 patients underwent neuroendoscopic procedures in our neurosurgical centers (median age19.1 ± 21.7 years, 50.7% male), primarily for aqueduct stenosis (25.6%) and intra- and periventricular tumors (25.1%). Among them, 104 (50.2%) patients underwent ETV, while 103 (49.8%) underwent other neuroendoscopic procedures (43.7% intracranial cysts fenestrations, 39.8% placement of intraventricular catheters, 3.9% intraventricular lavage, 4.9% septostomy, and 5.8% tumor biopsy). All postoperative infections were excluded. No significant differences were observed in preoperative symptoms, laboratory findings, or postoperative antibiotic usage between the two groups. The ETV group exhibited significantly more postoperative fever (37.5% vs. 19.4%, p = 0.005), particularly from the first night to the third night after the operation. This study substantiates the hypothesis that manipulation of the floor of third ventricle through endoscopic ventriculostomy may contribute to postoperative fever, rather than the neuroendoscopic procedure. Elevated temperatures were observable from the first night post-surgery and typically normalized by third day without necessitating specific treatment. Further prospective studies are warranted to elucidate the precise mechanisms underlying intraoperative manipulation.
神经内镜手术后的发热现象已有充分记录，但基于手术性质和部位的具体区分仍显不足。鉴于下丘脑在体温调节中的解剖学作用，我们推测内镜下第三脑室造瘘术（ETV）可能对术后发热有独特影响。本研究旨在探究这一现象。这项回顾性对比分析纳入了2017年1月至2023年9月期间接受神经内镜手术的所有患者。患者被分为ETV组和非ETV组，并对术后最初7天的体温进行了比较。收集了病例数、手术时长、症状、治疗方法及结果等全面数据。术后连续7天早晚测量体温，体温升高分为低热（37.5至38.2°C）和发热（≥38.3°C）。我们神经外科中心有207例患者接受了神经内镜手术（中位年龄19.1±21.7岁，50.7%为男性），主要病因是导水管狭窄（25.6%）和脑室内及脑室周围肿瘤（25.1%）。其中，104例（50.2%）患者接受了ETV，103例（49.8%）接受了其他神经内镜手术（43.7%为颅内囊肿开窗术，39.8%为脑室内置管，3.9%为脑室内灌洗，4.9%为造瘘术，5.8%为肿瘤活检）。所有术后感染均被排除。两组术前症状、实验室检查结果或术后抗生素使用情况均无显著差异。ETV组术后发热明显更多（37.5%对19.4%，p = 0.005），尤其是在术后第一晚至第三晚。本研究证实了以下假设：通过内镜下脑室造瘘术对第三脑室底部的操作可能导致术后发热，而非神经内镜手术本身。术后第一晚即可观察到体温升高，通常在第三天恢复正常，无需特殊治疗。有必要进行进一步的前瞻性研究以阐明术中操作背后的确切机制。
