Thymectomy in the Management of juvenile myasthenia gravis

Abstract

Introduction: Thymectomy provides a good opportunity for improvement in symptoms of selected children with myasthenia gravis and may be attended with a low risk of mortality.

Methods: Were retrospectively reviewed 14 children under 20 years who underwent thymectomy for myasthenia gravis between 1996 and 2020 in the Thoracic Surgery Department in Abderrahmane mami Hospital, Tunisia.

Results: There were 3 boys and 11 girls, with a mean age of 15.7 years (9–19 years). Ten children (71%) were operated on through a minimally invasive thoracic surgery approach. Six (60%) patients underwent thymectomy by video thoracoscopic, while 04 (20%) patients underwent thymectomy by video-assisted thoracoscopic surgery. Open thymectomy via median sternotomy (MS) was performed in 4 patients (29%); in two cases, the thymoma was locally advanced and invaded nearby structures, in the other two cases MS was performed because of the tumor size (7-9cm). Of the 14 patients, total thymectomy was performed in 10 cases, it was combined with mediastinal grease resection in 3 cases, and combined with atypical lung resection in 1 case. Two patients experienced postoperative complications. One patient suffered a myasthinic crisis, another had a postoperative chylothorax, one month later. There were no postoperative mortalities. Pathologic examination revealed thymic hyperplasia in 12 cases (85%) and thymoma in 2 cases (15%) which was classified as B3 stage II and AB stage I. After a mean follow-up period of 3 years, 12 of 14 patients were entirely off medication.

Conclusion: Complete thymic resection appears to be a safe intervention with few postoperative complications. Patients demonstrated a significant improvement compared to their pre-operative presentation.