Original Articles
Long-Term Clinical Outcome After Transcervical Thymectomy for Myasthenia Gravis

https://doi.org/10.1016/S0003-4975(98)00184-2Get rights and content

Abstract

Background. We reviewed the long-term clinical outcome after transcervical thymectomy for generalized myasthenia gravis without thymoma in 52 patients who had this procedure at The Toronto Hospital between 1977 and 1986, and compared the results with those reported after more radical surgical approaches.

Methods. Preoperative and postoperative patient evaluations were based on a modified Osserman classification. We defined complete remission as asymptomatic with normal strength and without medications for myasthenia gravis. The complete remission rate was selected as the best measure for comparison between different surgical approaches.

Results. The 52 patients were followed up for a mean of 8.4 years (±6.1 years [standard deviation]). The preoperative mean Osserman grade was 2.7 compared with 0.4 at final follow-up. Complete remission occurred in 44.2% of patients. Similar results are reported after transsternal thymectomy.

Conclusions. Comparable results after transcervical and transsternal thymectomy favor the use of the less radical approach.

Section snippets

Material and methods

We reviewed the clinical outcomes of 52 patients who had transcervical thymectomy for generalized MG without thymoma at The Toronto Hospital between 1977 and 1986. The 52 patients, all of whom returned for follow-up, were included in this review. Patients with thymoma demonstrated radiographically underwent transsternal thymectomy and were excluded from this series.

All patients underwent evaluation at The Toronto Hospital Neuromuscular Clinic by one of us who is a neurologist specializing in

Results

The study population consisted of 52 patients, 15 male and 37 female. Age ranged from 14 to 50 years with a mean age of 28.4 years. The mean follow-up period after thymectomy was 8.4 ± 6.1 years (± the standard deviation). The preoperative mean Osserman grade was 2.7 and the mean Osserman grade at last follow-up, 0.4. None of the patients sustained phrenic nerve injuries or other major surgical morbidity.

The improvement rate (at least one grade) was 90.4%, with palliation (minimal or no

Comment

Our series reports the long-term clinical outcome in patients with generalized MG without thymoma who underwent transcervical thymectomy. Our trial was not a prospective, randomized trial of transcervical versus transsternal thymectomy with blinded clinical assessments, which would have been more definitive. Lacking such a trial, we compared our results with those in previously published series reporting outcomes after differing surgical approaches and found similar complete remission rates.

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