THYMECTOMY FOR MYASTHENIA-GRAVIS

The pathophysiological role of the thymus in myasthenia gravis, and th e mechanism of therapeutic effect of thymectomy, are incompletely unde rstood. Nevertheless, thymectomy is a valuable treatment modality in s elected patients with generalised myasthenia gravis. There are several types of thymectomy operation, but no one operative approach is clear ly superior to the others. Total removal of the thymus gland is essent ial. Additional excision of associated mediastinal and cervical tissue , that may harbor ectopic thymic rests, is a controversial surgical is sue. Surgeons that advocate thymectomy through small, cosmetically fav ourable, incisions usually believe that simple removal of the thymus g land is an adequate operation. Surgeons that emphasise the importance of removing extrathymic tissue, in addition to the thymus gland, usual ly favour greater operative exposure through a median sternotomy. To m inimise operative morbidity, surgery for myasthenia gravis requires a multidisciplinary (neurology, surgery, anaesthesia) approach to peri-o perative care.