title: Surgery of myasthenia gravis associated or not with thymoma: a retrospective study of 43 cases.
abstract: OBJECTIVE
  Thymectomy is a surgical treatment of myasthenia gravis. Our goal is to report our experience in the surgical treatment of myasthenia gravis with or without thymoma and a review of the literature.
  
  
  METHODS
  This is a retrospective study over a period of 10 years (2001-2010) on 43 patients: 28 women and 15 men with a mean age of 39.3 years (range 16-68 years). The myasthenia gravis was confirmed by clinical, electromyographic data and the presence of antibodies to acetylcholine receptors.
  
  
  RESULTS
  Computed tomography objectified thymic mass in 14 cases (32.5%) enlarged thymus without visible mass in eight cases (18.6%). All patients received anticholinesterase, cortico steroids in 25 cases and in three cases plasmapheresis was required. The surgical approach was total sternotomy (n=32 cases), cervicotomy (n=2), cervical and manubriotomy (n=1), a manubriotomy (n=3) and a thoracotomy in five cases (lateralised thymoma). All patients underwent a total thymectomy associated or not with resection of the tumour. Intensive Care Unit was necessary for at least 24h up to six days. The postoperative course was marked by a myasthaenic crisis (n=2) and respiratory failure (n=3) with a favourable outcome. The prognosis was marked by a complete remission in 14 cases, partial remission in 11 patients, stabilisation (n=16 cases) and increasing crisis in two patients.
  
  
  CONCLUSIONS
  Thymectomy certainly allows clinical improvement and reduced crisis of myasthenia gravis. Long term monitoring will confirm the benefit of non-oncological thymectomy alone or in combination with standard treatments for patients with generalised myasthenia gravis without thymoma.
authors.affiliation: Department of Thoracic Surgery, Mohamed V Military University Hospital, Faculté de Médecine et de Pharmacie Université Mohamed V Souissi, 10100 Rabat, Morocco. Electronic address: hamoumimassine@hotmail.fr.
authors.forename: Massine
authors.initials: M
authors.lastname: El Hammoumi
authors.forename: Adil
authors.initials: A
authors.lastname: Arsalane
authors.forename: Fayçal
authors.initials: F
authors.lastname: El Oueriachi
authors.forename: El Hassane
authors.initials: el H
authors.lastname: Kabiri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013945:Thymoma; D013950:Thymus Gland / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000601:surgery
chemical_list: D001323:Autoantibodies
keywords: Myasthenia gravis; Sternotomy; Thymic hyperplasia; Thymoma