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Postoperative fever specific to neuroendoscopic procedures

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Abstract

The most common complication of neuroendoscopic surgery is postoperative fever without infection, although the details have not been discussed. The objective of this study was to clarify the clinical features and predicting factors of the postoperative fever following neuroendoscopic procedures. Between March 1998 and March 2013, 83 patients (46 males, 37 females; median age, 14.0 years) who had undergone surgery via the transventricular approach under a neuroendoscopic view were included in this study. A total of 86 neuroendoscopic procedures were performed in 83 patients. The incidence and duration of postoperative fever (≥38.0 and ≥39.0 °C) over the 7 days after surgery were examined. Moreover, the following variables predictive of fever were investigated: age, sex, neuroendoscopic procedure, operative time, and intraoperative irrigation fluid. The incidence of postoperative fever was 65.1 % (≥38.0 °C) and 15.1 % (≥39.0 °C). The median level of the highest fever was 38.6 °C. The fevers developed immediately after surgery and spontaneously disappeared within four postoperative days. Only age was related to postoperative fever (p = 0.032). The postoperative body temperature was negatively correlated with age in all 86 surgeries (p < 0.001, Spearman r = −0.396). In particular, patients under 10 years of age tended to have postoperative fever (p = 0.005). The result of this study demonstrated a peculiar pattern of fever following neuroendoscopic procedures. This type of fever did not cause serious problems; however, special attention should be paid to the high incidence of postoperative fever in patients under 10 years of age.

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Acknowledgments

This work was supported in part by grants-in-aid from the Tsuchiya Foundation and the Japanese Ministry of Education, Culture, Science and Technology.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Yasuyuki Kinoshita, Atsushi Tominaga, Taiichi Saitoh, Satoshi Usui, Takeshi Takayasu & Kaoru Kurisu

  2. Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Kazunori Arita

  3. Department of Neurosurgery, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima, 734-8530, Japan

    Tetsuhiko Sakoguchi

  4. Department of Clinical Oncology and Neuro-oncology Program, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Kazuhiko Sugiyama

Authors
  1. Yasuyuki Kinoshita
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  2. Atsushi Tominaga
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  3. Taiichi Saitoh
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  4. Satoshi Usui
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  5. Takeshi Takayasu
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  6. Kazunori Arita
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  7. Tetsuhiko Sakoguchi
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  8. Kazuhiko Sugiyama
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  9. Kaoru Kurisu
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Correspondence to Yasuyuki Kinoshita.

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Comments

Waleed A. Azab, New York, USA

Post-operative fever after intraventricular endoscopic procedures is a subject that has infrequently been explored in the literature. Dr. Kinoshita and his colleagues describe their experience and statistically analyze an observation of our everyday practice in a relatively large number of cases in a retrospective fashion. Analyzing the characteristics of fluid irrigation during their procedures would have been very useful in such a study.

Henry W. S. Schroeder, Greifswald, Germany

The authors investigated their series of 83 patients who underwent endoscopic intraventricular surgery regarding the occurrence of postoperative fever. The authors found an age-dependent relation. In children, the frequency of fever was significantly higher than in adults.

I was surprised by the high overall rate of postoperative fever (≥38.0 °C) which was 65.1 %. In my opinion, our fever rate is lower, but we have never examined this fact in detail. On occasion of this study, we will check our data more precisely.

In 15.1 % of the patients, fever of ≥39.0 °C occurred. Of course, it is important to rule out that an infection is the cause of this high-body temperature. The major fact to differentiate between infection and procedure-related increase in body temperature is the time of occurrence: while the procedure-related increase in body temperature occurs very early on the day of surgery or day 1, fever related to infection usually starts later on days 4 to 6.

I agree that manipulation of the hypothalamus and amount, kind, and temperature of the irrigation fluid are the most important factors that cause this elevation of the body temperature. Intraoperative hemorrhage with remaining blood may additionally cause fever. We have never seen procedure-related increase in body temperature in endoscopic procedure confined to the lateral ventricle, such as tumor biopsy or septostomy.

Fortunately, procedure-related increase in body temperature after endoscopic intraventricular procedures is only a minor temporary problem, but one should be aware of it to avoid unnecessary diagnostic steps like lumbar puncture which stress our patients!

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Kinoshita, Y., Tominaga, A., Saitoh, T. et al. Postoperative fever specific to neuroendoscopic procedures. Neurosurg Rev 37, 99–104 (2014). https://doi.org/10.1007/s10143-013-0505-7

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  • DOI: https://doi.org/10.1007/s10143-013-0505-7

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