Surgical Intervention
Thymectomy
- No consensus is in place on which surgical method is first line
- Based on a study, more severe cases of myasthenia gravis may benefit from thymectomy compared to patients with mild myasthenia gravis
- It is advisable that the patient be stabilized with immunotherapy before undergoing thymectomy to reduce perioperative morbidity & mortality
- Patients with acetylcholine receptor antibody-positive early-onset generalized myasthenia gravis with insufficient response to pyridostigmine therapy are candidates for thymectomy
- Video-assisted thoracoscopic surgery (VATS) may be considered in preference to the transsternal approach
- Many papers demonstrate superior results of VATS in terms of hospital stay, operative blood loss & patient satisfaction compared to the transsternal approach
Presence of Thymoma
- If patient has a thymoma it is highly recommended that the patient undergo early total thymectomy to prevent local tumor spread (although most tumors are benign)
- Tumor & adherent structures should be completely removed
- Chest cavity should be inspected for tumor implants
- 66% of patients with myasthenia gravis & nonmalignant thymoma were found to be symptom-free at 6 months-7 years after thymectomy & treatment with Prednisolone &/or Azathioprine therapy
Non-Thymomatous Autoimmune Myasthenia Gravis
- Thymectomy in the absence of tumor offers possibility of long-term benefit for those with generalized myasthenia gravis & anti-AChR antibodies
- It may increase the probability of improvement or drug-free remission
- Studies showing improvement have conflicting differences in baseline characteristics of prognostic factors & confounding variables (eg age, severity of myasthenia gravis)
- Regardless, most studies have found improvement or myasthenia gravis remission in patients undergoing thymectomy
- Improvement is slow & may take months-years
Ophthalmic Surgery
- For correction of ptosis &/or diplopia