title: Outcomes of thoracoscopic thymectomy in patients with juvenile myasthenia gravis.
abstract: BACKGROUND
  Myasthenia gravis (MG) is an autoimmune disorder of the postsynaptic neuromuscular junction resulting in fatigability of voluntary muscles. There has been increasing evidence supporting thymectomy for MG in adults, and evidence for the role of surgery in pediatric age groups is increasing. The purpose of this study is to describe the outcomes of our patients with juvenile MG undergoing thoracoscopic thymectomy.
  
  
  METHODS
  All patients with juvenile MG who underwent thoracoscopic thymectomy at Phoenix Children's Hospital between 1999 and 2014 were included. Patients were diagnosed by their treating neurologist. An Osserman and Genkins criterion was used to classify the severity of the disease and DeFilippi classification was used to assess remission.
  
  
  RESULTS
  Twelve patients underwent thoracoscopic thymectomy for juvenile MG during the time frame studied. Nine (75%) patients had an Osserman stage of IIB, with only two patients with ocular disease. There were no conversions to an open procedure. Seven (59%) patients had normal thymic histology, 4 (33%) had evidence of follicular hyperplasia and one (8%) had involutional changes. The median length of hospital stay was 2days (range 1-5days). There was no 30-day postoperative morbidity, reoperations or mortality. The median length of follow-up was 31months (range, 4-91months) and at the time of their last follow-up; all 12 (100%) patients had a DeFilippi Classification of 3 or better.
  
  
  CONCLUSIONS
  Surgery for MG in children is indicated for antibody-receptor-positive patients with moderate to severe disease. Thoracoscopic thymectomy is a safe and acceptable treatment for juvenile MG with good disease control. The low morbidity and shorter hospital duration make it an excellent option for consideration.
authors.affiliation: Department of Surgery, Mayo Clinic, Phoenix, AZ.
authors.forename: Awais
authors.initials: A
authors.lastname: Ashfaq
authors.affiliation: Department of Neurology, Phoenix Children's Hospital, Phoenix, AZ.
authors.forename: Saunder M
authors.initials: SM
authors.lastname: Bernes
authors.affiliation: Department of Surgery, Phoenix Children's Hospital, Phoenix, AZ.
authors.forename: Erica M
authors.initials: EM
authors.lastname: Weidler
authors.affiliation: Department of Surgery, Mayo Clinic, Phoenix, AZ; Department of Surgery, Phoenix Children's Hospital, Phoenix, AZ. Electronic address: dnotrica@phoenixchildrens.com.
authors.forename: David M
authors.initials: DM
authors.lastname: Notrica
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013906:Thoracoscopy / Q000379:methods*; D013934:Thymectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Juvenile; Myasthenia gravis; Surgical outcomes; Thoracoscopic; Thymectomy