Abstract
In recent years, thymectomy has become a widespread procedure in the treatment of myasthenia gravis (MG). Likelihood of remission was highest in preoperative mild disease classification (Osserman classification 1, 2A). In absence of thymoma or hyperplasia, there was no relationship between age and gender in remission with thymectomy. In MG treatment, randomized trials that compare conservative treatment with thymectomy have started, recently. As with non-randomized trials, remission with thymectomy in MG treatment was better than conservative treatment with only medication. There are four major methods for the surgical approach: transcervical, minimally invasive, transsternal, and combined transcervical transsternal thymectomy. Transsternal approach with thymectomy is the accepted standard surgical approach for many years. In recent years, the incidence of thymectomy has been increasing with minimally invasive techniques using thoracoscopic and robotic methods. There are not any randomized, controlled studies which are comparing surgical techniques. However, when comparing non-randomized trials, it is seen that minimally invasive thymectomy approaches give similar results to more aggressive approaches.
Highlights
Myasthenia gravis (MG) is a disease caused by abnormal neuromuscular transmission
Findings from non-randomized studies showed that thymectomy has contributed to MG remission and recovery [14, 21], before the MGTX study, usefulness of thymectomy was found to be controversial in the treatment of acetylcholine receptor (AChR) antibody-associated MG in absence of thymoma
Regardless of MG condition, all cases with thymoma should be operated by resection if possible
Summary
Myasthenia gravis (MG) is a disease caused by abnormal neuromuscular transmission. Studies have shown that the incidence of the disease, which is thought to be affecting the younger age group, has increased by 50 years and over. Surgical removal of the thymus has been an alternative treatment for this disease since Blalock et al [2] performed a successful thymectomy in a 26-years-old woman with MG and thymus cysts. Blalock et al [2] published their study about 20 patients with MG treated with transsternal thymectomy. There are still debates on the timing of thymectomy, treatment type in early ages, and surgical approaching techniques.
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