High incidence of morbidity following resection of metastatic pheochromocytoma in the spine.
Pheochromocytomas of the spine are uncommon and require careful preoperative planning. The authors retrospectively reviewed the charts of 5 patients with metastatic spinal pheochromocytoma who had undergone surgical treatment over the past 10 years at their medical center. They reviewed patient age, history of pheochromocytoma resection, extent and location of metastases, history of alpha blockage, surgical level, surgical procedure, postoperative complications, tumor recurrence, and survival. Metastases involved the cervical (1 patient), thoracic (3 patients), and lumbar (2 patients) levels. Preoperative treatment included primary pheochromocytoma resection, chemotherapy, alpha blockade, embolization, and radiation. Three patients had tumor recurrence, and 2 underwent 2-stage reoperations for tumor extension. Hemodynamic complications were common: 2 patients developed pulseless electrical activity arrest within 4 months after surgery, 1 patient had profound postoperative tachycardia with fever and an elevated creatine kinase level, and 1 patient experienced transient postoperative hypotension and paraplegia. One patient died of complications related to disseminated cerebral and spinal disease. With careful preoperative and surgical management, patients with symptomatic metastatic spinal pheochromocytoma can benefit from aggressive surgical treatment. Postoperative cardiovascular complications are common even months after surgery, and patients should be closely monitored long term.
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Paul E
PE
Kaloostian
Patricia L
PL
Zadnik
Jennifer E
JE
Kim
Mari L
ML
Groves
Jean-Paul
JP
Wolinsky
Ziya L
ZL
Gokaslan
Timothy F
TF
Witham
Ali
A
Bydon
Daniel M
DM
Sciubba
D000310:Adrenal Gland Neoplasms / Q000473:pathology*; D000328:Adult; D005260:Female; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010673:Pheochromocytoma / Q000556:secondary* / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D015996:Survival Rate
CK = creatine kinase; MIBG = metaiodobenzylguanidine; PEA = pulseless electrical activity; en bloc; oncology; spinal pheochromocytoma; spinal tumor