Surgical Approaches to Thymectomy in Myasthenia Gravis

A meta-analysis comparing different surgical techniques of thymectomy suggests that minimally invasive approaches can produce stable remissions of myasthenia gravis equal to those of open surgery in the hands of experienced surgeons committed to achieving true extended resections.

The relationship of the thymus to myasthenia gravis (MG) has been appreciated since Blalock reported the clinical benefit of thymectomy in myasthenic patients without thymomas 80 years ago. The original sternal-splitting surgical approach provides excellent visualization of the mediastinum, allowing extended removal of the entire thymus plus neighboring tissues, which is believed to be important for therapeutic effect (Neurologist 2003; 9:77). This approach was used in a randomized, blinded trial that confirmed the benefit of removal of non-neoplastic thymus (N Engl J Med 2016 375:511). However, open surgery is painful, costly, and results in relatively prolonged hospital stays. Accordingly, less invasive approaches have been developed, som…

Reviewing Author

Daniel B. Drachman, MD

Surgical Approaches to Thymectomy in Myasthenia Gravis

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Reviewing Author