Thymectomy for Nonthymomatous Myasthenia Gravis

Bagheri, Reza; Boonstani, Reza; Sadrizadeh, Ali; Salehi, Maryam; Afghani, Reza; Rahnama, Ali; Azmounfar, Vahab; Hakimian, Saeed; Firoozabadi, Mohammad Baradaran

doi:10.1097/imi.0000000000000490

Cited by 10 publications

(3 citation statements)

References 12 publications

(14 reference statements)

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“…Surgical treatment has grown in popularity, with clinical remission rates as high as 42% and clinical improvement rates as high as 94% (12,13) . The transsternal technique for thymectomy is a conventional treatment method, and we employed it to completely remove all thymic tissue, including adipose tissue in the anterior mediastinum, as thymic tissue extends beyond the typical thymus capsule (14,15) .…”

Section: Discussionmentioning

confidence: 99%

Outcome of Thymectomy in Myasthenia Gravis Patients

Sherif,

Aglan,

Abd-Ellatif

2023

Benha Medical Journal

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Background: Myasthenia gravis (MG) impairs voluntary muscle function by targeting the postsynaptic acetylcholine receptors, causing weakness and fatigue in the affected muscle group. This study aimed to assess the outcomes of thymectomy in MG patients, measure the extent of clinical improvement post-thymectomy by analysing changes in disease stage and medication needs, and identify prognostic factors that can aid in determining the most suitable patient selection. Methods: This prospective study was carried out on 53 patients aged greater than or equal to 18 years old, both sexes, scheduled for MG and underwent transsternal and VATS total thymectomy. Before surgery, each patient was evaluated by the neurologist and underwent a standard chest x-ray and a chest computed tomography. Both VATS and transsternal thymectomy were used as the surgical options in our study. Results: The majority of patients-who achieved full clinical remission-were classified under Osserman stages I, IIA, and III. In terms of the relationship between prognostic factors and complete clinical remission, females had a more favorable outcome following thymectomy (P-value = 0.019). Additionally, younger age was associated with better remission outcomes compared to older age groups (P-value < 0.001).Conclusions: Thymectomy is recommended for patients younger than 60 years with non-thymomatous, generalized AChR antibodyassociated myasthenia gravis. The early-onset MG, severe MG, female sex, and thymic hyperplasia are important factors helping to obtain better postoperative outcome. Thymectomy can reduce patient' s need for medication and the severity of MG regardless of age, sex, severity, or length of sickness, or thymic masses.

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Section: Discussionmentioning

confidence: 99%

Outcome of Thymectomy in Myasthenia Gravis Patients

Sherif,

Aglan,

Abd-Ellatif

2023

Benha Medical Journal

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“…In the recent decade, surgical techniques for thymectomy have been improvised through video and robotic assistance [ 167 ]. The video assistance thoracoscopic surgery (VATS) was much more effective in reducing hospitalization time, operative time, blood loss, and postoperative pain with improved remission as compared to transsternal surgery [ 168 ]. In addition, VATS also resulted in decreased demand for prednisone post-treatment [ 168 ].…”

Section: Traditional Current and Emerging Therapeutic Approaches For ...mentioning

confidence: 99%

“…The video assistance thoracoscopic surgery (VATS) was much more effective in reducing hospitalization time, operative time, blood loss, and postoperative pain with improved remission as compared to transsternal surgery [ 168 ]. In addition, VATS also resulted in decreased demand for prednisone post-treatment [ 168 ]. Refractory MG is commonly associated with the presence of MuSK autoantibodies, history of thymoma/ thymectomy, and female gender [ 169 ].…”

Section: Traditional Current and Emerging Therapeutic Approaches For ...mentioning

confidence: 99%

Myasthenia Gravis: Novel Findings and Perspectives on Traditional to Regenerative Therapeutic Interventions

Huang¹,

Wu²,

Wang³

et al. 2022

Aging and disease

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The prevalence of myasthenia gravis (MG), an autoimmune disorder, is increasing among all subsets of the population leading to an elevated economic and social burden. The pathogenesis of MG is characterized by the synthesis of autoantibodies against the acetylcholine receptor (AChR), low-density lipoprotein receptor-related protein 4 (LRP4), or muscle-specific kinase at the neuromuscular junction, thereby leading to muscular weakness and fatigue. Based on clinical and laboratory examinations, the research is focused on distinguishing MG from other autoimmune, genetic diseases of neuromuscular transmission. Technological advancements in machine learning, a subset of artificial intelligence (AI) have been assistive in accurate diagnosis and management. Besides, addressing the clinical needs of MG patients is critical to improving quality of life (QoL) and satisfaction. Lifestyle changes including physical exercise and traditional Chinese medicine/herbs have also been shown to exert an ameliorative impact on MG progression. To achieve enhanced therapeutic efficacy, cholinesterase inhibitors, immunosuppressive drugs, and steroids in addition to plasma exchange therapy are widely recommended. Under surgical intervention, thymectomy is the only feasible alternative to removing thymoma to overcome thymoma-associated MG. Although these conventional and current therapeutic approaches are effective, the associated adverse events and surgical complexity limit their wide application. Moreover, Restivo et al. also, to increase survival and QoL, further recent developments revealed that antibody, gene, and regenerative therapies (such as stem cells and exosomes) are currently being investigated as a safer and more efficacious alternative. Considering these above-mentioned points, we have comprehensively reviewed the recent advances in pathological etiologies of MG including COVID-19, and its therapeutic management.

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Der Stellenwert der Thymektomie ohne Thymom in der Therapie der Myasthenia gravis

Menghesha

Schroeter

Doerr

et al. 2021

Chirurg

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ZusammenfassungDer Stellenwert der Thymektomie in der Therapie der thymomfreien Myasthenia gravis blieb bis vor einiger Zeit umstritten. Die relativ geringe Inzidenz und Prävalenz der Erkrankung, die uneinheitliche Dokumentation in den verschiedenen Studien sowie die notwendige Langzeitbeobachtung zur Erfassung therapeutischer Effekte erschwerten das Generieren valider Daten. Die Veröffentlichung des MGTX-Trials 2016 im New England Journal of Medicine lieferte die ersten randomisiert-kontrollierten Daten, nach denen Patienten mit Acetylcholin-Rezeptor-Antikörper-positiver generalisierter Myasthenia gravis im Alter von 18 bis 65 Jahren von der chirurgischen Resektion des Thymus über eine mediane Sternotomie profitieren. Trotz fehlender Validierung des Vorteils der Thymektomie über minimal-invasive Techniken durch randomisiert-kontrollierte Studien scheinen diese das Outcome bestimmter Patientengruppen in ähnlicher Form positiv zu beeinflussen. So haben videoassistiert-thorakoskopische, roboterassistierte, subxiphoidale und transzervikale Zugangswege nicht nur ästhetische Vorteile, sondern zeigen in der Beeinflussung des Krankheitsverlaufs der Myasthenia gravis keine relevante Unterlegenheit gegenüber der medianen Sternotomie. Doch nicht nur der Nutzen und das ästhetische Ergebnis differieren, sondern auch die Erfolgsaussichten im Hinblick auf die Remission sind bei den Unterformen der Myasthenia gravis unterschiedlich. Die heterogene Gruppe der Myasthenien unterscheidet sich bezüglich des Auftretens von Autoantikörpern, der betroffenen Körperregionen und des Alters der Patienten bei Erstdiagnose. Schließlich ist die Thymektomie eine wirksame kausale Therapie der Myasthenia gravis.

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Thymectomy for Nonthymomatous Myasthenia Gravis

Cited by 10 publications

References 12 publications

Outcome of Thymectomy in Myasthenia Gravis Patients

Outcome of Thymectomy in Myasthenia Gravis Patients

Myasthenia Gravis: Novel Findings and Perspectives on Traditional to Regenerative Therapeutic Interventions

Der Stellenwert der Thymektomie ohne Thymom in der Therapie der Myasthenia gravis

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