Anesthetic management of a patient with McCune-Albright syndrome complicated by pathological cervical fracture: a case report.

BACKGROUND: McCune–Albright syndrome (MAS) is a rare sporadic disorder caused by post-zygotic activating mutations in GNAS, classically characterized by café-au-lait macules, endocrine hyperfunction, and fibrous dysplasia of bone (FD). MAS presents challenges in anesthetic management due to airway difficulties, cervical spine deformities, and bone lesions. CASE PRESENTATION: A 40-year-old female with a history of growth hormone-secreting macroadenoma, for which she underwent transsphenoidal resection, presented with a pathological cervical spine fracture. Enhanced cervical MRI showed destruction of high cervical vertebrae and multiple space-occupying lesions. Awake fiberoptic intubation was performed under sedation, followed by general anesthesia induction and maintenance with a balanced intravenous-inhalational technique. CONCLUSION: This case highlights the importance of preoperative airway assessment and the use of awake fiberoptic bronchoscopy for intubation in MAS patients, especially those with cervical spine lesions. Personalized anesthetic strategies are essential for optimizing patient safety.