At the Eye of the Hurricane! Perioperative Management of an Unoptimized Metastatic Pheochromocytoma Presenting for Emergency Neurosurgery.

Metastatic pheochromocytoma (PCC) is a rare entity arising from extra-adrenal tissue. We report the perioperative management of a young woman presenting with metastatic PCC to the vertebral body resulting in vertebral collapse and spinal cord compression necessitating emergency surgery. There are no reports of anesthetic management of a patient with unoptimized metastatic PCC presenting for emergency neurosurgery under general anesthesia. Our anesthetic goals were to maintain a deep anesthetic plane with stable hemodynamics, facilitate intraoperative neuromonitoring, manage catecholamine surges during anesthetic induction, tumor resection, and manage perioperative massive blood loss. The successful perioperative management of metastatic PCC has become possible with the vast armamentarium of anesthetic drugs and intraoperative advanced monitoring techniques. In addition, our role in understanding the pathophysiology and course of the disease is essential to ensure low morbidity and mortality of such cases in their most vulnerable perioperative period.