Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1987 May;205(5):496–503. doi: 10.1097/00000658-198705000-00007

Aggressive surgical approach for drug-free remission from myasthenia gravis.

J E Fischer, H T Grinvalski, M S Nussbaum, H J Sayers, R E Cole, F J Samaha
PMCID: PMC1493029  PMID: 3579398

Abstract

A series of 27 patients with generalized myasthenia gravis is presented. All patients were treated by a sternal split and extended thymectomy and radical mediastinal dissection. The overall drug-free remission rate was 63%, although three additional patients are likely to achieve drug-free remission in the near future, with the total drug-free remission rate then being 74%. Of the remaining patients, all but three improved and require decreased medication, for an improvement rate of approximately 90%. One patient who has not improved had an invasive malignant thymoma. Drug-free remission was achieved in 46% of the male patients and in 82% of the female patients despite that the mean duration of disease was greater than 3.5 years. There was one serious complication, that of sterile sternal dehiscence. There was no mortality. The results suggest that an aggressive, radical surgical approach to myasthenia gravis, even in a group of patients considered somewhat less favorable because of a relatively long duration of disease, can result in a high percentage of drug-free remissions. Radical surgery for myasthenia gravis appears to be the treatment of choice, with medical therapy being reserved for those patients who are not likely to survive operation.

Full text

PDF
496

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bartoccioni E., Scuderi F., Scoppetta C., Evoli A., Tonali P., Guidi L., Bartoloni C., Terranova T. Myasthenia gravis, thymectomy, and antiacetycholine receptor antibody. J Neurol. 1980;224(1):9–15. doi: 10.1007/BF00313202. [DOI] [PubMed] [Google Scholar]
  2. Blalock A., Mason M. F., Morgan H. J., Riven S. S. MYASTHENIA GRAVIS AND TUMORS OF THE THYMIC REGION: REPORT OF A CASE IN WHICH THE TUMOR WAS REMOVED. Ann Surg. 1939 Oct;110(4):544–561. doi: 10.1097/00000658-193910000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Buckingham J. M., Howard F. M., Jr, Bernatz P. E., Payne W. S., Harrison E. G., Jr, O'Brien P. C., Weiland L. H. The value of thymectomy in myasthenia gravis: a computer-assisted matched study. Ann Surg. 1976 Oct;184(4):453–458. doi: 10.1097/00000658-197610000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cohn H. E., Solit R. W., Schatz N. J., Schlezinger N. Surgical treatment in myasthenia gravis. A 27 year experience. J Thorac Cardiovasc Surg. 1974 Dec;68(6):876–885. [PubMed] [Google Scholar]
  5. Crile G., Jr Thymectomy through the neck. Surgery. 1966 Feb;59(2):213–215. [PubMed] [Google Scholar]
  6. ELMQVIST D., HOFMANN W. W., KUGELBERG J., QUASTEL D. M. AN ELECTROPHYSIOLOGICAL INVESTIGATION OF NEUROMUSCULAR TRANSMISSION IN MYASTHENIA GRAVIS. J Physiol. 1964 Nov;174:417–434. doi: 10.1113/jphysiol.1964.sp007495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hankins J. R., Mayer R. F., Satterfield J. R., Turney S. Z., Attar S., Sequeira A. J., Thompson B. W., McLaughlin J. S. Thymectomy for myasthenia gravis: 14-year experience. Ann Surg. 1985 May;201(5):618–625. doi: 10.1097/00000658-198505000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Jaretzki A., 3rd, Bethea M., Wolff M., Olarte M. R., Lovelace R. E., Penn A. S., Rowland L. A rational approach to total thymectomy in the treatment of myasthenia gravis. Ann Thorac Surg. 1977 Aug;24(2):120–130. doi: 10.1016/s0003-4975(10)63720-4. [DOI] [PubMed] [Google Scholar]
  9. Kirschner P. A., Osserman K. E., Kark A. E. Studies in myasthenia gravis. Transcervical total thymectomy. JAMA. 1969 Aug 11;209(6):906–910. [PubMed] [Google Scholar]
  10. Klingen G., Johansson L., Westerholm C. J., Sundstroöm C. Transcervical thymectomy with the aid of mediastinoscopy for myasthenia gravis: eight years' experience. Ann Thorac Surg. 1977 Apr;23(4):342–347. doi: 10.1016/s0003-4975(10)64138-0. [DOI] [PubMed] [Google Scholar]
  11. Lennon V. A., Lambert E. H. Myasthenia gravis induced by monoclonal antibodies to acetylcholine receptors. Nature. 1980 May 22;285(5762):238–240. doi: 10.1038/285238a0. [DOI] [PubMed] [Google Scholar]
  12. Masaoka A., Monden Y., Seike Y., Tanioka T., Kagotani K. Reoperation after transcervical thymectomy for myasthenia gravis. Neurology. 1982 Jan;32(1):83–85. doi: 10.1212/wnl.32.1.83. [DOI] [PubMed] [Google Scholar]
  13. Masaoka A., Nagaoka Y., Kotake Y. Distribution of thymic tissue at the anterior mediastinum. Current procedures in thymectomy. J Thorac Cardiovasc Surg. 1975 Oct;70(4):747–754. [PubMed] [Google Scholar]
  14. Mulder D. G., Herrmann C., Buckberg G. D. Effect of thymectomy in patients with myasthenia gravis. A sixteen year experience. Am J Surg. 1974 Aug;128(2):202–206. [PubMed] [Google Scholar]
  15. Mulder D. G., Herrmann C., Jr, Keesey J., Edwards H. Thymectomy for myasthenia gravis. Am J Surg. 1983 Jul;146(1):61–66. doi: 10.1016/0002-9610(83)90260-x. [DOI] [PubMed] [Google Scholar]
  16. Olanow C. W., Wechsler A. S., Roses A. D. A prospective study of thymectomy and serum acetylcholine receptor antibodies in myasthenia gravis. Ann Surg. 1982 Aug;196(2):113–121. doi: 10.1097/00000658-198208000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Riemer R. W. Transcervical approach to the thymus and to mediastinal tumors. Am J Surg. 1972 Apr;123(4):393–397. doi: 10.1016/0002-9610(72)90189-4. [DOI] [PubMed] [Google Scholar]
  19. Rosenberg M., Jaúregui W. O., Herrera M. R., Roncoroni A. J., Rojas O. R., Olmedo G. S. Recurrence of thymic hyperplasia after trans-sternal thymectomy in myasthenia gravis. Chest. 1986 Jun;89(6):888–889. doi: 10.1378/chest.89.6.888. [DOI] [PubMed] [Google Scholar]
  20. Rosenberg M., Jáuregui W. O., De Vega M. E., Herrera M. R., Roncoroni A. J. Recurrence of thymic hyperplasia after thymectomy in myasthenia gravis. Its importance as a cause of failure of surgical treatment. Am J Med. 1983 Jan;74(1):78–82. doi: 10.1016/0002-9343(83)91122-1. [DOI] [PubMed] [Google Scholar]
  21. SIMPSON J. A. An evaluation of thymectomy in myasthenia gravis. Brain. 1958 Mar;81(1):112–144. doi: 10.1093/brain/81.1.112. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES