Case Report Pediatr Neurosurg 2004;40:196–202 DOI: 10.1159/000081939 Delayed Persistent Hyperthermia after Resection of a Craniopharyngioma Athanasios S. Chatzisotiriou Panayiotis K. Selviaridis Vasilios A. Kontopoulos Athanasios V. Kontopoulos Ioannis A. Patsalas Department of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece Received: March 25, 2004 Accepted after revision: August 2, 2004 Panayiotis K. Selviaridis, MD, Ass. Prof. of Neurosurgery Department of Neurosurgery, AHEPA University Hospital Aristotle University of Thessaloniki, Stilp. Kiriakidi 1 GR–54636 Thessaloniki (Greece) Tel. +30 2310994725, Fax +30 2310994708, E-Mail selv@med.auth.gr ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2004 S. Karger AG, Basel 1016–2291/04/0404–0196$21.00/0 Accessible online at: www.karger.com/pne Key Words Central fever W Craniopharyngioma W Dysthermia Abstract Objective and Importance: Disorders of thermoregula- tion are occasionally noticed after operations in the region of the third ventricle. Various factors are usually implicated, but the actual contribution of each of them is rather vague. Apart from the presumed derangement in the functional connections of the hypothalamic region, mechanical reasons of compression should be thor- oughly considered. Clinical Presentation: An 8.5-year- old patient was subjected to a radical excision of a cra- niopharyngioma compressing the third ventricle. Three months after the operation, he presented with a febrile syndrome of unknown origin. All usual investigations proved negative. Intervention: A chronic subdural hy- groma was evacuated, an encapsulated CSF cyst of the suprachiasmatic cistern was drained and the lamina ter- minalis incised resulting in a moderate control of pyrex- ia. The administration of chlorpromazine contributed to the final resolution of hyperthermia. Conclusion: Postop- erative hyperthermia may result following resection of tumors of the hypothalamic floor. It should not be blindly attributed to hypothalamic dysfunction as surgical causes could be implicated as well. Chlorpromazine could be a useful adjunct to the correction of the dis- order. Copyright © 2004 S. Karger AG, Basel Introduction Temperature elevations are frequent in neurosurgical patients, especially in the postoperative period, and often cause much diagnostic confusion. Common causes in- clude upper respiratory tract infection, urinary tract infec- tion, intravenous line sepsis, ventriculoperitoneal shunt infections, wound infection, drug fever and central fever. Early recognition of the latter is extremely important to avoid either unnecessary and potential harmful antimi- crobial regimens or prolonged hospitalization [1]. Fever of central origin is sometimes observed in stroke [2] or traumatic brain injury [3]. Defective thermoregula- tion, however, is usually ascribed to lesions in the region of the third ventricle. In most cases, the exact mechanism is not elucidated. Mechanisms that are implicated are direct hypothalamic lesions, segregation of endogenous pyrogens or deficits in sensing temperature elevations. We present a case of a young patient with a craniopha- ryngioma, in whom persistent hyperthermia appeared 3 months following the removal of the lesion and remained at high levels thereafter. In this case, central fever was probably due to the pres- ence of an extra-axial fluid collection. A cyst containing CSF and presumably compressing the third ventricle was initially implicated in the pathogenesis of the temperature dysregulation, but, eventually, it turned out that function- al reasons could be another causative factor. After a series of tedious and exhausting clinical and laboratory evalua- tions, all negative for the presence of infection, the disease