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Thymectomy is effective in the treatment of myasthenia gravis (MG) and, in the opinion of many, should be the cornerstone of therapy for patients with generalized symptoms. Controversy persists, however, as to which operation is the procedure of choice. To resolve this controversy, those analyzing the results of thymectomy must understand the reasons for the differing opinions, the goal of surgery, the potential of the various surgical techniques for achieving total thymectomy, and the problems in the analysis of results. This report discusses these problems and presents evidence that there is a direct relationship between the extent of thymic resection and the results obtained.
Although arguments may be presented to refute some of the statements herein, it is hoped that this analysis will lead to better understanding and to resolution of the controversy, standardization of measurements, and the adoption of accepted analytic techniques.
Technical goal of thymectomy.
The technical goal of thymectomy in the treatment of MG is complete removal of all thymic tissue. [1-15] It is established that the thymus plays a central role in the pathogenesis of this autoimmune illness. Pathologic and immunologic studies support this thesis. [16-18] Complete neonatal thymectomy prevents experimental autoimmune myasthenia gravis, whereas incomplete removal does not. [19] In addition, clinically incomplete resections have been a cause of failure requiring reoperation. [20-24] As little as 3 g of residual thymus has caused severe symptoms, and its removal was therapeutic. [21]
Why the controversy?
Contrary to common perception, the anatomy of the human thymus is complex. It consists of multiple lobes in the neck and mediastinum, often not contiguous, as well as gross and microscopic thymic tissue widely and invisibly distributed in cervical and mediastinal fat [25] (Figure 1). Complete removal cannot be ascertained by visual inspection at surgery, and gross and microscopic thymic tissue may be overlooked unless en bloc resection …
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- Comparison of results.
- Unanswered questions.
- Summary and recommendations.
- Acknowledgments
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- Figures & Data
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