Summary
We made a retrospective assessment of the long-term outcome in 247 consecutive patients with myasthenia gravis (MG) who underwent thymectomy in the period January 1971–December 1985. In 84 cases a thymoma was found at surgery, while 163 patients had a non-neoplastic thymus. The duration of symptoms before surgery, the age at onset of the disease and the presence of germinal centres in the thymus did not appear to influence the prognosis. Patients with a non-neoplastic thymus showed a better response to thymectomy. Thymoma was associated with more severe disease and with a higher mortality; moreover, more thymoma patients required corticosteroid treatment in order to achieve good therapeutic results. In our opinion, thymectomy is indicated in the treatment of generalized MG, while ocular myasthenia seems not to be improved by the removal of the thymus.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bartoccioni E, Scuderi F, Scoppetta C, Evoli A, Tonali P, Guidi L, Bartoloni C, Terranova T (1980) Myasthenia gravis, thymectomy and anti-acetylcholine receptor antibody. J Neurol 224:9–15
Bever CT, Aboias JR, Aquino AV, Penn AS, Lovelace RE, Rowland LP (1983) Prognosis of ocular myasthenia. Ann Neurol 14:516–519
Buckingham JM, Howard FM Jr, Bernatz PE, Payne WS, Harrison EG, O'Brian PC, Weiland LH (1976) The value of thymectomy in myasthenia gravis. Ann Surg 184:453–457
Clark RE, West PN, Florence JM, Ferguson TB (1980) Thymectomy for myasthenia gravis in the young adult: long-term results. J Thorac Cardiovasc Surg 80:696–701
Drachman DB, Adams RN, Josifek JLF, Self SG (1982) Functional activities of autoantibodies to acetylcholine receptors and clinical severity of myasthenia gravis. N Engl J Med 307:769–775
Evoli A, Tonali P, Scoppetta C, David P (1983) Myasthenia gravis in the elderly: report of 37 cases. J Am Geriatr Soc 31:352–355
Genkins G, Papatestas AE, Horowitz SH, Kornfeld P (1975) Studies in myasthenia gravis: early thymectomy. Electrophysiologic and pathologic correlations. Am J Med 58:517–524
Gerein AN, Srivastava SP, Burgess JB (1978) Thymoma: a ten years review. Am J Surg 136:49–53
Goldman AJ, Herrman C, Keesey JC, Mulder DG, Brown WJ (1975) Myasthenia gravis and invasive thymoma: a twenty year experience. Neurology 25:1021–1025
Hankins JR, Mayer RF, Satterfield JR, Turney SZ, Attar S, Sequeira AJ, Thompson BW, McLaughlin JS (1985) Thymectomy for myasthenia gravis: 14-year experience. Ann Surg 201:618–625
Henze TH (1986) Therapie der Myasthenia gravis. Dtsch Med Wochenschr 111:507–509
Inderbitzi R, Glutz L, Nachbur B (1986) Die Bedeutung der Thymektomie in der Behandlung der Myasthenia gravis pseudoparalytica im Berner Krankengut. Schweiz Med Wochenschr 116:1297–1302
Le Brigand H, Levasseur P, Miranda AR, Gaud C, Wojakowski I (1980) Resultats du traitement chirurgical de la miasthenie. Ann Chir Thorac Cardiovasc 34:169–172
Lefvert AK, Bergstrom K, Matell G, Osterman PO, Pirskanen R (1978) Determination of acetylcholine receptor antibody in myasthenia gravis: clinical usefulness and pathogenetic implications. J Neurol Neurosurg Psychiatry 41:394–403
Lindstrom J (1977) An assay for antibodies to human acetylcholine receptor in serum from patients with myasthenia gravis. Clin Immunol Immunopathol 7:36–43
Mikkelsen B (1986) Thymectomy in late onset myasthenia gravis. Acta Neurol Scand 73:633–635
Monden Y, Nakahara K, Kagotami K, Fujii Y, Masaoka A, Kawashima Y (1984) Myasthenia gravis with thymoma: analysis and postoperative prognosis for 65 patients with thymomatous MG. Ann Thorac Surg 38:46–52
Monden Y, Nakahara K, Nanjo S, Fujii Y, Matsumura A, Masaoka A, Kawashima Y (1984) Invasive thymoma with myasthenia gravis. Cancer 54:2513–2518
Mulder DG, Herrman C, Keesey J, Edward H (1983) Thymectomy for myasthenia gravis. Am J Surg 146:61–66
Oosterhuis HJGH (1981) Observations of the natural history of myasthenia gravis and the effect of thymectomy. Ann NY Acad Sci 377:678–689
Osserman KE, Genkins G (1971) Studies in myasthenia gravis: review of a twenty year experience in over 1200 patients. Mt Sinai J Med 38:497–537
Paletto MG, Maggi G (1982) Thymectomy in the treatment of myasthenia gravis: results in 320 patients. Int Surg 67:13–16
Papatestas AE, Genkins G, Horowitz SH, Kornfeld P (1976) Thymectomy in myasthenia gravis: pathologic, clinical and electrophysiologic correlations. Ann N Y Acad Sci 274:555–573
Robinson CLN (1983) The role of surgery of the thymus for myasthenia gravis. Ann R Coll Surg Engl 65:145–151
Rowland LP (1980) Controversies about the treatment of myasthenia gravis. J Neurol Neurosurg Psychiatry 43:644–659
Rubin JW, Ellison RG, Moore HV, Pai GP (1981) Factors affecting response to thymectomy for myasthenia gravis. J Thorac Cardiovasc Surg 82:720–728
Schumm F, Weitholter H, Fateh-Moghadam A, Dichgans J (1985) Thymectomy in myasthenia with pure ocular symptoms. J Neurol Neurosurg Psychiatry 48:332–337
Schwab RS, Leland C (1953) Sex and age in myasthenia gravis as critical factors in incidence and remission. JAMA 153:1270–1273
Scoppetta C, Tonali P, Evoli A, David P, Crucitti F, Vaccario ML (1979) Treatment of myasthenia gravis. J Neurol 222:11–21
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Evoli, A., Batocchi, A.P., Provenzano, C. et al. Thymectomy in the treatment of myasthenia gravis: report of 247 patients. J Neurol 235, 272–276 (1988). https://doi.org/10.1007/BF00314173
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00314173