PONM09 Thymectomy: its role in the management of myasthenia gravis. Issue 11 (22nd October 2010)

• Record Type: Journal Article
• Authors: Spillane, J; Kullmann, D M; Taylor, C; Hirsch, N P; Howard, R
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 81:Issue 11(2010)
• Page Start: e62
• Page End: e63
• Publication Date: 2010-10-22
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp.2010.226340.182
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Background: The role of thymectomy in the management of MG continues to be debated. In the absence of an adequate RCT, it is essential to review clinical experience. Aim: To perform a 10 year audit of cases of thymectomy for MG in a tertiary referral centre. Methods: Medical case notes of all patients who underwent thymectomy were retrospectively reviewed. Results: 79 patients were identified. 22 were male. Average age at thymectomy was 32.5. Indications for thymectomy included: persistence of generalised symptoms (62%), bulbar symptoms (6%), a combination of both (8%), ocular MG (9%) and thymoma (15%). Over 90% were AChR ab positive. 45% had an enlarged gland on mediastinal imaging. Average length of ICU postoperatively was 2.2 days. Immediate postthymectomy complications included pneumonia (3.7%), pneumothorax (3.7%) and wound infection (2.5%); 7.5% suffered a hypertrophic scar. There were no long-term complications. Thymic histology revealed hyperplasia (47%), thymoma (22%), atrophic changes (10%) and a normal gland (21%). 77% of patients achieved an improvement in one point or more on the MGFA scale postthymectomy during follow-up (6 months–2 years). Conclusion: Thymectomy is commonly performed for MG and is associated with a sustained improvement in the majority of our patients.