Correlation of endoscopic third ventriculostomy with postoperative body temperature elevation: a single-center retrospective comparative study

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.