How to avoid intraoperative complications of active paragangliomas?

Background: Paragangliomas (PGs) are very rare neuroendocrine tumors that can be found in unusual locations such as the spinal canal. Some PGs may be endocrinologically active, containing neurotransmitters such as noradrenaline, adrenaline, and serotonin. This can lead to unexpected neurotransmitter release during the removal of PGs, leading to a hypertensive crisis. Case Description: We present two patients who underwent surgical removal of a secretory filum terminale PG. Conclusion: If laboratory tests are suggestive of a secretory tumor, surgery should include anesthesiologic preparation similar to cases of pheochromocytoma.