TRANSCERVICAL THYMECTOMY FOR MYASTHENIA-GRAVIS

The use of transcervical thymectomy in the treatment of myasthenia gra vis remains controversial. We retrospectively reviewed our experience with this procedure to determine its usefulness in the management of m yasthenia gravis. Fifty-three selected myasthenic patients without thy moma underwent transcervical thymectomy between 1977 and 1991. The mea n age (27.5 +/- 1.5 years), duration of symptoms (3.2 +/- 1.0 years), and preoperative Osserman classification (13% class I, 53% class IIA, 28% class IIB, 6% class III) were consistent with previous reports. Th e average hospitalization was 3.0 +/- 0.3 days, but has been 1.6 +/- 0 .2 days since 1987 (n = 14). There were no deaths, and no patients req uired mechanical ventilation for more than 24 hours. Average follow-up was 4.3 +/- 0.4 years with a range of 0 to 13 years. Eighty-one perce nt of patients are symptom free, and 9 of 21 (43%) are in complete rem ission at least 5 years postoperatively. One patient required a transs ternal exploration for worsening symptoms. Clinical improvement contin ued over an extended period of time, and a statistically significant d ecrease in symptoms was evident comparing the first and sixth postoper ative years. Patients were more likely to be improved or in remission if thymectomy was performed within the first year of the onset of symp toms (p < 0.05). Osserman classification, thymus histology, and patien t age were not prognostic indicators. Transcervical thymectomy is effe ctive surgical therapy for myasthenia gravis in selected patients with out thymoma.