Surgery of Myasthenia Gravis Associated or Not With Thymoma: A Retrospective Study of 43 Cases

• Published in: Heart, lung & circulation lung & circulation, 2013-09, Vol.22 (9), p.738-741
• Main Authors: Hammoumi, Massine El, MD, Arsalane, Adil, MD, Oueriachi, Fayçal El, MD, Kabiri, El Hassane, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Autoantibodies - blood; Cardiovascular; Electromyography; Female; Humans; Male; Middle Aged; Myasthenia gravis; Myasthenia Gravis - blood; Myasthenia Gravis - pathology; Myasthenia Gravis - physiopathology; Myasthenia Gravis - surgery; Retrospective Studies; Sternotomy; Thymic hyperplasia; Thymoma; Thymus Gland - metabolism; Thymus Gland - pathology; Thymus Gland - physiopathology; Thymus Gland - surgery
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2013.02.010

Objectives Thymectomy is a surgical treatment of myasthenia gravis. Our goal is to report our experience in the surgical treatment of myasthenia gravis with or without thymoma and a review of the literature. Materials and Methods This is a retrospective study over a period of 10 years (2001–2010) on 43 patients: 28 women and 15 men with a mean age of 39.3 years (range 16–68 years). The myasthenia gravis was confirmed by clinical, electromyographic data and the presence of antibodies to acetylcholine receptors. Results Computed tomography objectified thymic mass in 14 cases (32.5%) enlarged thymus without visible mass in eight cases (18.6%). All patients received anticholinesterase, cortico steroids in 25 cases and in three cases plasmapheresis was required. The surgical approach was total sternotomy ( n = 32 cases), cervicotomy ( n = 2), cervical and manubriotomy ( n = 1), a manubriotomy ( n = 3) and a thoracotomy in five cases (lateralised thymoma). All patients underwent a total thymectomy associated or not with resection of the tumour. Intensive Care Unit was necessary for at least 24 h up to six days. The postoperative course was marked by a myasthaenic crisis ( n = 2) and respiratory failure ( n = 3) with a favourable outcome. The prognosis was marked by a complete remission in 14 cases, partial remission in 11 patients, stabilisation ( n = 16 cases) and increasing crisis in two patients. Conclusion Thymectomy certainly allows clinical improvement and reduced crisis of myasthenia gravis. Long term monitoring will confirm the benefit of non-oncological thymectomy alone or in combination with standard treatments for patients with generalised myasthenia gravis without thymoma.