[Significance of thymectomy in the treatment of myasthenia gravis pseudoparalytica in a patient sample in Bern]

Abstract

A retrospective assessment has been made of the medium to long-term outcome in 40 consecutive patients with myasthenia gravis in whom thymectomy was performed. Treatment of myasthenia gravis, when combined with thymectomy, was associated with a 40.6% complete remission rate and with partial remission in 43.8% of our cases, provided no thymoma was present. In the latter cases (n = 8) the results of surgical treatment were significantly poorer. This is in accordance with other reports in the literature. Based on our experience we are convinced that radical extended thymectomy, including resection of neighbouring mediastinal fat tissue, using longitudinal sternotomy for access, is the method of choice. This mode of treatment has been advocated by a number of authors in recent years, and we have reason to believe that this therapeutic concept will give rise to improved results in the patient group with thymoma also. In our series, such factors as sex, age and time interval between onset of disease and operation date were of minor importance and had no significant prognostic value. Due regard must of course be paid to the unspecific risks associated with age. Operative thymectomy is indicated whenever myasthenia gravis is diagnosed, with the exception of those cases presenting with ocular symptoms alone (group 1 of Osserman's classification).