Narrative Review of Surgery for Myasthenia Gravis

Abstract

Myasthenia Gravis (MG) is a rare autoimmune disorder characterized by antibody mediated blockade of neuromuscular transmission. Up until the last decade, evidence suggesting benefit of thymectomy for myasthenia gravis has been based on non-randomized control studies. Our paper serves as an expert narrative review of new literature pertaining to surgical management of myasthenia gravis based on review of articles from PubMed and Cochrane database from date of inception through June 14, 2021. We used the MeSH search terms: “myasthenia gravis”; “thymectomy”; “thymoma”; and “surgery” to identify any new relevant articles for inclusion in our review. The results of these studies are summarized below. We reviewed multiple articles including two randomized control trials. As a result of these studies over the past decade, the American Academy of Neurology’s most recent practice advisory, published online March 25, 2020, gives a level ‘B’ recommendation for thymectomy for MG in patients with acetylcholine receptor antibody-positive generalized MG age 18-65 years old. They additionally noted the need for further discussion surrounding the benefits and risks of surgery and whether minimally invasive approaches to thymectomy would provide the same benefits as the traditional transsternal approach. Evidence recommending thymectomy during pregnancy remains limited due to lack of available data. Emerging evidence suggests that performance of video-assisted or robotic-assisted thymectomy is feasible, but further study is needed due to a lack of randomized control trials.