Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy

Shrager, Joseph B.; Deeb, Maher; Mick, Rosemarie; Brinster, Clay J; Childers, Henry; Marshall, M. Blair; Kucharczuk, John C.; Galetta, Steven; Bird, Shawn J.; Kaiser, Larry R.

doi:10.1016/s0003-4975(02)03722-0

Cited by 109 publications

(69 citation statements)

References 36 publications

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“…1516 As new safer surgical approaches evolve, thymectomy may be investigated in OMG. 17 The remission frequency was 18.5% for all patients treated with prednisone and zero for patients treated with pyridostigmine alone. The remission rate in the pyridostigmine group could have been artificially low owing to poor follow up.…”

Section: Discussionmentioning

confidence: 93%

Ocular motor dysfunction and ptosis in ocular myasthenia gravis: effects of treatment

Kupersmith

2005

British Journal of Ophthalmology

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Aim: The optimal treatment of ocular myasthenia gravis (OMG) remains unknown. The authors evaluated the efficacy of prednisone and pyridostigmine in reducing diplopia, ocular motor dysfunction, and ptosis in patients with OMG. Methods: Review of records from a clinical database from one neuro-ophthalmology service of patients presenting with OMG between 1990 and 2002, excluding those who developed generalised MG within the first month after diagnosis. Institutional review board approval was obtained for this study. Participants/interventions: Non-randomised, unmasked, therapy was given. 55 patients with diplopia in primary or downward gaze and clinically demonstrable extraocular muscle dysfunction received prednisone. 34 patients who had contraindications to steroids or who refused treatment with prednisone received pyridostigmine only. Over 5 days the daily prednisone dose was increased to 50-60 mg and then gradually reduced to 10 mg, followed by further reduction as tolerated. The pyridostigmine dose was begun at 180 mg daily and increased as tolerated. Main outcome measures: Follow up evaluations, performed at 1, 3-6, 12, and 24 months, detailed the frequency of ptosis and diplopia and the amount of ocular motor deviation in primary and downward gaze. Results: The prednisone and pyridostigmine groups were similar for age, sex, acetylcholine receptor antibody level, prism cover test results for primary and downward gaze, diplopia in primary and downward gaze, and unilateral ptosis. Bilateral ptosis was present in 32.4% of the pyridostigmine group and 10.9% of the prednisone group (p = 0.02). The prednisone group showed resolution in primary gaze diplopia, downgaze diplopia, unilateral ptosis, and bilateral ptosis in 73.5%, 75.5%, 85.7%, and 98%, respectively at 1 month. The benefit persisted at 3-6, 12, and 24 months except for the bilateral ptosis. The pyridostigmine group showed resolution in primary gaze diplopia, downgaze diplopia, unilateral ptosis, and bilateral ptosis in 6.9%, 17.2%, 50%, and 76.7% of patients after 1 month of treatment. The prism cover results improved (p = 0.003) in the prednisone group only. In the prednisone group, four patients had no response to therapy. Among the 51 prednisone responsive patients, there were 33 recurrences in 26 patients. 12 patients, all prednisone treated, had remissions. Except for three patients who developed diabetes, no patient developed a clinically significant systemic corticosteroid complication. Conclusion: These results suggest that 50-60 mg daily prednisone followed by lower doses (10 mg or less) has the benefit of resolving ptosis and diplopia that lasts for at least 2 years in approximately 70% of patients.

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Section: Discussionmentioning

confidence: 93%

Ocular motor dysfunction and ptosis in ocular myasthenia gravis: effects of treatment

Kupersmith

2005

British Journal of Ophthalmology

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“…It is the controversial part of this approach that it may be inadequate to reveal thymus fully and that residual thymus tissue may remain in the left posterior side. However, clinical improvement similar to transsternal thymectomy has been reported in various series [26][27][28].…”

Section: Surgical Methodsmentioning

confidence: 79%

Thymectomy in Myasthenia Gravis

Aydın¹,

Ulaş²,

Mutlu³

et al. 2017

Eurasian J Med

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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.Keywords: Extended thymectomy, follow-up, myasthenia gravis, thoracoscopic thymectomy ÖZ Miyastenia gravis tedavisinde son yıllarda timektomi giderek yaygınlaşan bir prosedür haline geldi. Preoperatif hafif hastalık sınıflaması (Osserman sınıflaması 1, 2A) olanlarda remisyon ihtimali en yüksek olarak gösterildi. Timoma veya hiperplazi yokluğunda timektomi ile remisyon sağlamada yaş ve cinsiyetin ilişkisi gösterilemedi. Miyastenia gravis tedavisinde timektomi ile konservatif tedaviyi karşılatıran randomize çalışmalar yeni yayınlanmaya başlandı. Nonrandomize çalışmalarda olduğu gibi Miyastenia gravis tedavisinde timektomi ile remisyon, sadece ilaçla konservatif tedaviden daha iyi bulundu. Cerrahi yaklaşım için transservikal, minimal invaziv, transsternal ve kombine transservikal transsternal timektomi olmak üzere dört major yöntem bulunmaktadır. Transsternal yaklaşımla timektomi yıllardır kabul gören standart cerrahi yaklaşımdır. Son yıllarda torakoskopik ve robotik yöntemin kullanıldığı minimal invaziv tekniklerle timektomi sıklığı artmaktadır. Cerrahi teknikleri karşılaştıran randomize, kontrollü çalışmalar bulunmamaktadır. Ancak nonrandimize çalışmalar arasındaki karşılaştırmalara bakıldığında minimal invaziv timektomi yaklaşımlarının daha agresif yaklaşımlara benzer sonuçlar verdiği görülmektedir.

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“…However, there is no consensus on either one of these factors [7,16]. Although some studies have reported no differences in remission rates with thymectomy performed before sternotomy [12,[17][18][19], many surgeons of today still perform extended thymectomy method through sternotomy [5,[7][8][9]11,13]. The rates of complete remission as a response to thymectomy in patients who stop taking the medication and return to their routine activities range from 10% to 40%, which suggests that factors that affect the outcome after thymectomy are not clearly defined [20,21].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the postoperative first and fifth year outcomes in patients who had undergone thymectomy for Myastenia Gravis

Dural¹,

Günal²,

Koçer³

et al. 2015

Turk J Clin Lab

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Aim:The efficiency of thymectomy for treating patients with Myasthenia gravis is a controversial issue. Thus, this study aimed to investigate the efficiency of thymectomy in the treatment of myasthenia gravis based on long-term follow-up results. Material and Methods:The first and fifth year clinical outcomes of 27 patients who had undergone median sternotomy and extended thymectomy for myasthenia gravis between January 1995 and January 2004 were compared statistically. Results:No statistically significant differences were found between the postoperative first and fifth year clinical outcomes of the patients. Conclusions:Thymectomy is a reliable method in the treatment of myasthenia gravis with respect to its long-term outcomes. The outcomes obtained at the end of the first and fifth year of thymectomy are not different.

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Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy

Cited by 109 publications

References 36 publications

Ocular motor dysfunction and ptosis in ocular myasthenia gravis: effects of treatment

Ocular motor dysfunction and ptosis in ocular myasthenia gravis: effects of treatment

Thymectomy in Myasthenia Gravis

Comparison of the postoperative first and fifth year outcomes in patients who had undergone thymectomy for Myastenia Gravis

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