wsh supports perl, so you could go that route.

Also, Premia's (ahem... StarBase's) CodeWright supports perl as a macro language. I think it's ActiveState(?). In addition, CodeWright supports syncing between Visual Studio and itself. You can also use an emacs keymap if you're so inclined.

I've been using it for about three years now, and while it does have its warts, it's a pretty decent editor.