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Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

Many physicians caring for patients with myasthenia gravis (MG) are convinced that thymectomy plays an important role in treatment, even though the operation has not been proved effective. I share their conviction, believe there is supporting evidence, and recommend total thymectomy as the cornerstone of therapy for adult patients with generalized MG.

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References

  1. Task Force of the Myasthenia Gravis Foundation of America, Inc. Myasthenia gravis: recommendations for clinical research standards. Neurology 2000; 55: 16–23.

    Google Scholar 

  2. Jaretzki A III, Barohn RB, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. AnnThorac Surg 2000; 70: 327–334.

    Article  PubMed  Google Scholar 

  3. Weinberg A, Gelijns A, Moskowitz A, Jaretzki A. Myasthenia gravis: outcomes analysis. 2000. www.neurology.org. Reprints available via Myasthenia Gravis Foundation of America, Inc., 5841 Cedar Lake Road (Suite 204), Minneapolis, MN 55416.

    Google Scholar 

  4. Melms A. Guidelines for the Evaluation of the Non-Thymomatous Thymus in Myasthenia Gravis. Report of the Thymic Pathology Task Force of the Medical Scientiifc Advisory Board of the Myasthenia Gravis Foundation of America, Inc., 2001, in preparation.

    Google Scholar 

  5. Andrews PI. Standards for the Evaluation of Children with Myasthenia Gravis. Report of the Pediatric Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America, Inc., 2001, in preparation.

    Google Scholar 

  6. Kirschner PA, Osserman KE, Kark AE. Studies in myasthenia gravis: transcervical total thymectomy. JAMA 1969; 209: 906–910.

    Article  PubMed  CAS  Google Scholar 

  7. Kark AE, Papatestas AE. Some anatomic features of the transcervical approach for thymectomy. Mt Sinai J Med 1971; 38: 580–584.

    PubMed  CAS  Google Scholar 

  8. Jaretzki A III, Wolff M. “Maximal” thymectomy for myasthenia gravis: surgical anatomy and operative technique. JThorac Cardiovasc Surg 1988;96:711– 716.

    Google Scholar 

  9. Papatestas AE, Genkins G, Kornfield P, et al. Effects of thymectomy in myasthenia gravis. Ann Surg 1987; 206: 79–88.

    Article  PubMed  CAS  Google Scholar 

  10. Jaretzki A III. Thymectomy for myasthenia gravis: an analysis of the controversies regarding technique and results. Neurology 1997; 48 (Suppl 5): S52–S63.

    Article  Google Scholar 

  11. Blalock A, Harvey AM, Ford FF, Lilienthal J Jr. The treatment of myasthenia gravis by removal of the thymus gland. JAMA 1941; 117: 1529–1533.

    Article  Google Scholar 

  12. Keynes G. The surgery of the thymus gland. Br J Surg 1946; 32: 201–214.

    Article  Google Scholar 

  13. Kark AE, Kirschner PA. Total thymectomy by the transcervical approach. Br J Surg 1971; 56: 321–326.

    Article  Google Scholar 

  14. Faulkner SL, Ehyai AS, Fisher RD, Fenichel GM, Bender HW. Contemporary managment of myasthenia gravis: the clinical role of thymectomy. AnnThorac Surg 1977; 23: 348–352.

    Article  PubMed  CAS  Google Scholar 

  15. Olanow CW, Wechsler AS, Roses AD. A prospective study of thymectomy and serum acetylcholine receptor antibodies in myasthenia gravis. Ann Surg 1982; 196: 113–121.

    Article  PubMed  CAS  Google Scholar 

  16. Vincent A, Newsom-Davis J, Newton P, Beck N. Acetylcholine receptor antibody and clinical response to thymectomy in myasthenia gravis. Neurology 1983; 33: 1276–1282.

    Article  PubMed  CAS  Google Scholar 

  17. Hankins JR, Mayer RF, Satterfield JR, et al. Thymectomy for myasthenia gravis: 14 year experience. Ann Surg 1985; 201: 618–625.

    Article  PubMed  CAS  Google Scholar 

  18. Otto TJ, Strugalska H. Surgical treatment for myasthenia gravis. Thorax 1987; 42: 199–204.

    Article  PubMed  CAS  Google Scholar 

  19. Cooper J, Jaretzki A III, Mulder DG, Papatestas AS. Symposium: thymectomy for myasthenia gravis. Contemp Surg 1989; 34: 65–86.

    Google Scholar 

  20. Papatestas AE, Cooper J, Jaretzki A III, Mulder DG. Symposium: thymectomy for myasthenia gravis. Contemp Surg 1989; 34: 65–85.

    Google Scholar 

  21. Verma P, Oger J. Treatment of acquired autoimmune myasthenia gravis: a topic review. Can J Neurol Sci 1992; 19: 360–375.

    PubMed  CAS  Google Scholar 

  22. Drachman DB. Myasthenia gravis. N Engl J Med 1994; 330: 1797–1810.

    Article  PubMed  CAS  Google Scholar 

  23. Penn AS. Thymectomy for myasthenia gravis. In: Lisak RP, ed. Handbook ofMyasthenia Gravis andMyasthenic Syndromes. New York, Marcel Dekker, 1994, pp. 321–339.

    Google Scholar 

  24. Mack MJ, Landreneau RD, Yim AP, Hazelrigg SR, Scruggs GR. Results of video-assisted thymectomy in patients with myasthenia gravis. J hToarc Cardiovasc Surg 1996; 112: 1352–1360.

    Article  CAS  Google Scholar 

  25. Penn AS, Jaretzki A III, Wolff M, Chang HW, Tennyson V. Thymic abnormalities: antigen or antibody? Response to thymectomy in myasthenia gravis. Ann NY Acad Sci 1981; 377: 786–803.

    Article  PubMed  CAS  Google Scholar 

  26. Wekerle H, Muller-Hermelink HK. The thymus in myasthenia gravis. Curr Top Pathol 1986; 75: 179–206.

    Article  PubMed  CAS  Google Scholar 

  27. Younger DS, Worrall BB, Penn AS. Myasthenia gravis: historical perspective and overview. Neurology Suppl 1997; 48: S1–S17.

    Article  Google Scholar 

  28. Penn AS, Lovelace RE, Lange DJ, et al. Experimental myasthenia gravis in neonatally thymectomized rabbits. Neurology 1977; 27: 365.

    Google Scholar 

  29. Masaoka A, Monden Y, Seike Y, Tanioka T, Kagotani K. Reoperation after trans-cervical thymectomy for myasthenia gravis. Neurology 1982; 32: 83–85.

    Article  PubMed  CAS  Google Scholar 

  30. Rosenberg M, Jauregui WO, Vega MED, Herrera MR, Roncoroni AJ. Recurrence of thymic hyperplasia after thymectomy in myasthenia gravis: its importance as a cause of failure of surgical treatment. Am J Med 1983; 74: 78–82.

    Article  PubMed  CAS  Google Scholar 

  31. Henze A, Biberfeld P, Christensson B, Matell G, Pirskanen R. Failing transcervical thymectomy in myasthenia gravis, an evaluation of transsternal re-exploration. Scand JThorac Cardiovasc Surg 1984; 18: 235–238.

    Article  PubMed  CAS  Google Scholar 

  32. Rosenberg M, Jauregui WO, Herrera MR, et al. Recurrence of thymic hyperplasia after trans-sternal thymectomy in myasthenia gravis. Chest 1986; 89: 888–891.

    Article  PubMed  CAS  Google Scholar 

  33. Jaretzki A III, Penn AS, Younger DS, et al. “Maximal” thymectomy for myasthenia gravis: results. J Thorac Cardiovasc Surg 1988; 95: 747–757.

    PubMed  Google Scholar 

  34. Miller RG, Filler-Katz A, Kiprov D, Roan R. Repeat thymectomy in chronic refractory myasthenia gravis. Neurology 1991; 41: 923–924.

    Article  PubMed  CAS  Google Scholar 

  35. Kornfeld P, Merav A, Fox S, Maier K. How reliable are imaging procedures in detecting residual thymus after previous thymectomy. Ann NY Acad Sci 1993; 681: 575–576.

    Article  PubMed  CAS  Google Scholar 

  36. Masaoka A, Monden Y. Comparison of the results of transsternal simple, trans-cervical simple and extended thymectomy. Ann NY Acad Sci 1981; 377: 755–764.

    Article  PubMed  CAS  Google Scholar 

  37. Matell G, Lebram G, Osterman PO, Pirskanen R. Follow up comparison of supra-sternal vs transsternal method for thymectomy in myasthenia gravis. Ann NY Acad Sci 1981; 377: 844–845.

    Article  Google Scholar 

  38. Yim AP, Izzat MB. VATS approach to the thymus. In: Yim AP, Hazelrigg SR, Izzat B, et al., eds. Minimal Access Cardiothoracic Surgery. Philadelphia, WB Saunders, 1999, pp. 209–215.

    Google Scholar 

  39. Kirby TJ, Ginsberg RJ. Transcervical thymectomy. In: Shields T, LoCicero J, Ponn R, ed. GeneralThoracic Surgery, 5th ed. Philadelphia, Lippincott Williams and Wilkins, 2000, pp. 2239–2242.

    Google Scholar 

  40. Masaoka A, Nagaoka Y, Kotake Y. Distribution of thymic tissue at the anterior mediastinum: current procedures in thymectomy. J hTorac Cardiovasc Surg 1975; 70: 747–754.

    CAS  Google Scholar 

  41. Fukai I, Funato Y, Mizuno Y, Hashimoto T, Masaoka A. Distribution of thymic tissue in the mediastinal adipose tissue. J hToarcCardiovasc Surg 1991; 101: 1099–1102.

    CAS  Google Scholar 

  42. Bulkley GB, Bass KN, Stephenson R, et al. Extended cervicomediastinal thymectomy in the integrated management of myasthenia gravis. Ann Surg 1997; 226: 324–335.

    Article  PubMed  CAS  Google Scholar 

  43. Clark RE, Marbarger JP, West PN, et al. Thymectomy for myasthenia gravis in the young adult. J hTorac Cardiovasc 1980; 80: 696–701.

    CAS  Google Scholar 

  44. Jaretzki A III. Transcervical-transsternal “maximal” thymectomy for myasthenia gravis (Video). Society of Thoracic Surgeons’ Film Library, 1996; P.O. Box 809285, Chicago, IL 60680–9285.

    Google Scholar 

  45. Lennquist S, Andaker L, Lindvall B, Smeds S. Combined cervicothoracic approach in thymectomy for myasthenia gravis. Acta Chir Scand 1990; 156: 53–61.

    PubMed  CAS  Google Scholar 

  46. Andersen M, Jorgensen J, Vejlsted H, Clausen PP. Transcervical thymectomy in patients with non-thymomatous myasthenia gravis. Scand JThorac Cardiovasc Surg 1986; 20: 233–235.

    Article  PubMed  CAS  Google Scholar 

  47. Kagotani K, Monden Y, Nakaha K, et al. Anti-acetylcholine receptor antibody titer with extended thymectomy in myasthenia gravis. JThorac Cardiovasc Surg 1985; 90: 7–12.

    PubMed  CAS  Google Scholar 

  48. Monden Y, Nakahara K, Fujii Y, et al. Myasthenia gravis in elderly patients. AnnTh orac Surg 1985; 39: 433–436.

    Article  CAS  Google Scholar 

  49. Mulder DG, Graves M, Hermann C Jr. Thymectomy for myasthenia gravis: recent observations and comparison with past experience. AnnThorac Surg 1989;48:551– 555.

    Google Scholar 

  50. Fujii N, Itoyama Y, Machi M, Goto I. Analysis of prognostic factors in thymectomized patients with myasthenia gravis: correlation between thymic lymphoid cell subsets and postoperative clinical course. J Neurol Sci 1991; 105: 143–149.

    Article  PubMed  CAS  Google Scholar 

  51. Nussbaum MS, Rosenthal GJ, Samaha FJ, et al. Management of myasthenia gravis by extended thymectomy with anterior mediastinal dissection. Surgery 1992; 112: 681–688.

    PubMed  CAS  Google Scholar 

  52. Frist WH, Thirumalai S, Doehring CB, et al. Thymectomy for the myasthenia gravis patient: factors influencing outcome. AnnThorac Surg 1994; 57: 334–338.

    Article  PubMed  CAS  Google Scholar 

  53. Masaoka A, Yamakawa Y, Niwa H, et al. Extended thymectomy for myasthenia gravis: a 20 year review. AnnThorac Surg 1996; 62: 853–859.

    Article  PubMed  CAS  Google Scholar 

  54. Detterbeck FC, Scott WW, Howard JF, et al. One hundred consecutive thymectomies for myasthenia gravis. AnnThorac Surg 1996; 62: 242–245.

    Article  PubMed  CAS  Google Scholar 

  55. Mulder DG. Extended transsternal thymectomy. Chest Surg Clin North Am 1996; 6: 95–105.

    CAS  Google Scholar 

  56. Fischer JE, Grinvalski HT, Nussbaum MS, et al. Aggressive surgical approach for drug-free remission from myasthenia gravis. Ann Surg 1987; 205: 496–503.

    Article  PubMed  CAS  Google Scholar 

  57. Hatton P, Diehl J, Daly BDT, et al. Transternal radical thymectomy for myasthenia gravis: a 15-year review. AnnThorac Surg 1989; 47: 838–840.

    Article  PubMed  CAS  Google Scholar 

  58. Mulder DM. Extended transsternal thymectomy. In: Shields TW, ed. GeneralThoracic Surgery, 5th ed. Philadelphia, Lippincott Williams and Wilkins, 2000, pp. 2233–2237.

    Google Scholar 

  59. Steinglass KM. Extended transsternal thymectomy for myasthenia gravis (Video) 2001. Available from the Myasthenia Gravis Foundation of America, Inc., 5841 Cedar Lake Road (Suite 204 ), Minneapolis, MN 55416.

    Google Scholar 

  60. Blalock A, Mason MF, Morgan HJ, Riven SS. Myasthenia gravis and tumors of the thymus region: report of a case in which the tumor was removed. Am Surg 1939; 110: 544–561.

    CAS  Google Scholar 

  61. Clagett OT, Eaton LM. Surgical treatment of myasthenia gravis. JThorac Surg 1947; 16: 62–80.

    PubMed  CAS  Google Scholar 

  62. Blalock A. Thymectomy in the treatment of myasthenia gravis: report of 20 cases. JThorac Surg 1944; 13: 1291–1308.

    Google Scholar 

  63. Olanow CW. The surgical management in myasthenia gravis. In: Sabiston DC Jr, Spencer FC, eds. Surgery of the Chest, 6th ed. Philadelphia, WB Saunders, 1995, pp. 1100–1122.

    Google Scholar 

  64. LoCicero J III. The combined cervical and partial sternotomy approach for thymectomy. Chest Surg Clin North Am 1996; 6: 85–93.

    Google Scholar 

  65. Trastek VF. Thymectomy. In: Kaiser LR, Krin IL, Spray TL, eds. Mastery of Cardiothoracic Surgery. Philadelphia, Lippincott-Raven, 1998, pp. 105–111.

    Google Scholar 

  66. deCampos JRM, Filomeno LTB, Marchiori PE, Jatene FB. Partial sternotomy approach to the thymus. In: Yim AP, Hazelrigg SR, Izzat B, Landreneau RJ, Mack MJ, Naunheim KS, eds. Minimal Access Cardiothoracic Surgery. Philadelphia, WB Saunders, 1999, pp. 205–208.

    Google Scholar 

  67. Granone P, Margaritora S, Cesario A, Galetta D. Thymectomy (transsternal) in myasthenia gravis via video assisted infra-mammary cosmetic incision. Eur J Cardiothorac Surg 1999; 15: 861–863.

    Article  PubMed  CAS  Google Scholar 

  68. Olanow CW, Wechsler AS. The surgical management of myasthenia gravis. In: Sabiston DC, Spencer FC, eds. Gibbon’s Surgery of the Chest, 4th ed. Philadelphia, WB Saunders, 1983, pp. 849–869.

    Google Scholar 

  69. Olanow CW, Wechsler AS. The surgical management in myasthenia gravis. In: Sabiston DC Jr, ed. Textbook of Sugreyr, 14th ed. Philadelphia, WB Saunders, 1991, pp. 1801–1814.

    Google Scholar 

  70. Trastek VF, Pairolero PC. Standard thymectomy. In: Shields TW, ed. Mediastinal Surgery. Philadelphia, Lea and Febiger, 1991, pp. 365–368.

    Google Scholar 

  71. Trastek VF, Pairolero PC. Surgery of the thymus gland. In: Shields TW, ed. GeneralThoracic Surgery, 4th ed. Baltimore, William and Wilkins, 1994, pp. 1770–1781.

    Google Scholar 

  72. Olanow CW, Wechsler AS, Sirotkin-Roses M, Stajich J, Roses AD. Thymectomy as primary therapy in myasthenia gravis. Ann NY Acad Sci 1987; 505: 595–606.

    Article  PubMed  CAS  Google Scholar 

  73. Wilkins EW Jr. Thymectomy. Mod Techn Surg 1981; 38: 1–13.

    Google Scholar 

  74. Cooper J, Al-Jilaihawa A, Pearson F, Humphrey J, Humphrey HE. An improved technique to facilitate transcervial thymectomy for myasthenia gravis. AnnThorac Surg 1988; 45: 242–247.

    Article  PubMed  CAS  Google Scholar 

  75. Bril V, Kojic S, Ilse W, Cooper J. Long-term clinical outcome after transcervical thymectomy for myasthenia gravis. AnnThorac Surg 1998; 65: 1520–1522.

    CAS  Google Scholar 

  76. Durelli L, Maggi G, Casadio C, et al. Actuarial analysis of the occurrence of remission following thymectomy for myasthenia gravis in 400 patients. J Neurol Neurosurg Psychiatry 1991; 54: 406–411.

    Article  PubMed  CAS  Google Scholar 

  77. Klingen G, Johansson L, Westerholm CJ, Sundstroom C. Transcervical thymectomy with the aid of mediastinoscopy for myasthenia gravis: eight years’ experience. AnnThorac Surg 1977; 23: 342–347.

    Article  PubMed  CAS  Google Scholar 

  78. Kirby TJ, Ginsberg RJ. Transcervical thymectomy. In: Shields TW, ed. Mediastinal Surgery. Philadelphia, Lea and Febiger, 1991, pp. 369–371.

    Google Scholar 

  79. Hagan JA, Patterson GA. Surgery of myasthenia gravis. In: Pearson FG, ed. Thoracic Surgery. New York, Churchill Livingstone, 1995, pp. 1511–1521.

    Google Scholar 

  80. Papatestas AE, Genkins G, Kornfeld P, Horowitz S, Kark AE. Transcervical thymectomy in myasthenia gravis. Surg Gynecol Obstet 1975; 140: 535–540.

    PubMed  CAS  Google Scholar 

  81. Sugarbaker DJ. Thoracoscopy in the management of anterior mediastinal masses. AnnThorac Surg 1993; 56: 653–656.

    Article  PubMed  CAS  Google Scholar 

  82. Roviaro G, Rebuffat C, Varoli F, et al. Vidiothoracoscopic excision of mediastinal masses: indications and technique. AnnThorac Surg 1994; 58: 1679–1684.

    Article  PubMed  CAS  Google Scholar 

  83. Sabbagh MN, Garza JJS, Patten B. Thoracoscopic thymectomy in patients with myasthenia gravis. Muscle Nerve 1995; 18: 1475–1477.

    Article  PubMed  CAS  Google Scholar 

  84. Yim APC, Kay RLC, Ho JKS. Video-assisted thoracoscopic thymectomy for myasthenia gravis. Chest 1995; 108: 1440–1443.

    Article  PubMed  CAS  Google Scholar 

  85. Mack MJ, Scruggs GR. Video-assisted thymectomy. In: Shields T, LoCicero J, Ponn R, eds. GeneralThoracic Surgery, 5th ed. Philadelphia, Lippincott Williams and Wilkins, 2000, pp. 2243–2249.

    Google Scholar 

  86. Mineo TC, Pompeo E, Ambrogi V, et al. Adjuvant pneumomediastinum in thoracoscopic thymectomy for myasthenia gravis. AnnThorac Surg 1996;62:1210– 1212.

    Google Scholar 

  87. Novellino L, Longoni M, Spinelli L, et al. “Extended” thymectomy, without sternotomy, performed by cervicotomy and thoracoscopic technique in the treatment of myasthenia gravis. Int Surg 1994; 79: 378–381.

    PubMed  CAS  Google Scholar 

  88. Scelsi R, Ferro MT, Scelsi L, et al. Detection and morphology of thymic remnants after video-assisted thoracoscopic thymectomy (VATET) in patients with myasthenia gravis. Int Surg 1996; 81: 14–17.

    PubMed  CAS  Google Scholar 

  89. Lawless JF. Statistical Models and Methods for Life Table Data. New York, John Wiley and Sons, 1982, pp. 52–99.

    Google Scholar 

  90. Olak J, Chiu RCJ. A surgeon’s guide to biostatistical inferences. Part II. ACS Bull 1993; 78: 27–31.

    Google Scholar 

  91. Blackstone EH. Outcome analysis using hazard function methodology. AnnThorac Surg 1996; 61: S2–S7.

    Article  PubMed  CAS  Google Scholar 

  92. McQuillen MP, Leone MG. A treatment carol: thymectomy revisited. Neurology 1977: 1103–1106.

    Google Scholar 

  93. Viet HR, Schwab RS. Thymectomy for myasthenia gravis. In: Veit HR, ed. Records of Experience ofMassachusetts General Hospital. Springfield, Charles C. Thomas, 1960, pp. 597–607.

    Google Scholar 

  94. Oosterhuis HJ. Observations of the natural history of myasthenia gravis and the effect of thymectomy. Ann NY Acad Sci 1981; 377: 678–689.

    Article  PubMed  CAS  Google Scholar 

  95. Sanders DS, Kaminski HJ, Phillips LH, JR, Jaretzki A III. Letter to the editor. J Am Coll Surg 2001; 193: 340–344.

    Article  PubMed  CAS  Google Scholar 

  96. Buckingham JM, Howard FM, Bernatz PE. The value of thymectomy in myasthenia gravis: a computer-assisted matched study. Ann Surg 1976; 184: 453–458.

    Article  PubMed  CAS  Google Scholar 

  97. Gronseth S, Barohn RJ. Practice parameters: thymectomy for autoimmune myasthenia gravis (an evidence base review). Neurology 2000; 55: 7–15.

    Article  PubMed  CAS  Google Scholar 

  98. Newsom-Davis J. Thymectomy trial in non-thymomatous myasthenia gravis patients receiving immunosuppressive therapy. 2001, in preparation.

    Google Scholar 

  99. Rowland LP. Controversies about the treatment of myasthenia gravis. J Neurol Neurosurg Psychiatry 1980; 43: 644–659.

    Article  CAS  Google Scholar 

  100. Mulder DG. Thymectomy for myasthenia gravis: reply to letter to editor. AnnThor Surg 1990; 49: 688–689.

    Article  Google Scholar 

  101. Hoch W, McConville J, Melms A, Newsom-Davis J, Vinvent A. Autoantibodies to the receptor tyrosine kinase MuSK in patients with myasthenia gravis without acetylcholine receptor antibodies. Nat Med 2001; 7: 365–368.

    Article  PubMed  CAS  Google Scholar 

  102. Lindberg C, Andersen O, Larsson S, Oden A. Remission rate after thymectomy in myasthenia gravis when the bias of immunosuppressive therapy is eliminated. Acta Neurol Scand 1992; 86: 323–328.

    Article  PubMed  CAS  Google Scholar 

  103. Rodriguez M, Gomez MR, Howard F, Taylor WF. Myasthenia gravis in children: long term follow-up. Ann Neurol 1983; 13: 504–510.

    Article  PubMed  CAS  Google Scholar 

  104. Mulder DG, Herrmann C Jr, Keesey J, Edwards H. Thymectomy for myasthenia gravis. Am J Surg 1983; 146: 61–66.

    Article  PubMed  CAS  Google Scholar 

  105. Kirschner PA. Myasthenia gravis. In: Shields T. ed. GeneralThoracic Surgery, 5th ed. Philadelphia, Lippincott Williams and Wilkins, 2000, pp. 2207–2218.

    Google Scholar 

  106. Budde JM, Morris CD, Gal AA, Mansour KA, Miller JI. Predictors of outcome in thymectomy for myasthenia gravis. AnnThorac Surg 2001; 72: 197–202.

    Article  PubMed  CAS  Google Scholar 

  107. Mack MJ. Commentary on minimally access thymectomy for myasthenia gravis. In: Yim AP, Hazelrigg SR, Izzat B, et al., eds. Minimal Access Cardiothoracic Surgery. Philadelphia, WB Saunders, 1999, pp. 218–219.

    Google Scholar 

  108. Lanska D. Indications for thymectomy in myasthenia gravis. Neurology 1990; 40: 1828–1829.

    Article  PubMed  CAS  Google Scholar 

  109. Keesey JC. A treatment algorithm for autoimmune myasthenia in adults. Ann NY Acad Sci 1998; 841: 753–768.

    Article  PubMed  CAS  Google Scholar 

  110. Soliven BC, Lange DJ, Penn AS, Younger DS III. Seronegative myasthenia gravis. Neurology 1988; 38: 514–517.

    Article  PubMed  CAS  Google Scholar 

  111. Schumm F, Wietholter H, Fateh-Mogbadan A, Dichgans J. Thymectomy in myasthenia with pure ocular symptoms. J Neurol Neurosurg Psychiatry 1985; 48: 332–337.

    Article  PubMed  CAS  Google Scholar 

  112. Rubin JW, Ellison RG, Moore HV, Pai GP. Factors affecting response to thymectomy for myasthenia gravis. JThorac Cardiovasc Surg 1981; 82: 720–728.

    PubMed  CAS  Google Scholar 

  113. Monden Y, Nakahara K, Kagotani K, et al. Effects of preoperative duration of symptoms on patients with myasthenia gravis. AnnThorac Surg 1984; 38: 287–291.

    Article  PubMed  CAS  Google Scholar 

  114. DeFilippi VJ, Richman DP, Ferguson MK. Transcervical thymectomy for myasthenia gravis. AnnThorac Surg 1994; 57: 194–197.

    Article  Google Scholar 

  115. Adams C, Theodorescu D, Murphy E, Shandling B. Thymectomy in juvenile myasthenia gravis. J Child Neurol 1990; 5: 215–218.

    Article  PubMed  CAS  Google Scholar 

  116. Andrews PI, Massey JM, Howard JF, Sanders DB. Race, sex, and puberty influence onset, severity, and outcome in juvenile myasthenia gravis. Neurology 1994; 44: 1208–1214.

    Article  PubMed  CAS  Google Scholar 

  117. Andrews PI. A treatment algorithm for autoimmune myasthenia gravis in children. Ann NY Acad Sci 1998; 841: 789–802.

    Article  CAS  Google Scholar 

  118. Seybold ME. Thymectomy in childhood myasthenia gravis. Ann NY Acad Sci 1998; 841: 731–741.

    Article  PubMed  CAS  Google Scholar 

  119. Lovelace RE, Younger DS. Myasthenia gravis with thymoma. Neurology 1997; 48: S76–S81.

    Article  Google Scholar 

  120. Shields TW. Thymic tumors. In: Shields TW, ed. GeneralThoracic Surgery, 5th ed. Philadelphia, Lippincott Williams and Wilkins, 2000, pp. 2181–2205.

    Google Scholar 

  121. Ellis K, Austin JHM, Jaretzki A III. Radiologic detection of thymoma in patients with myasthenia gravis. Am J Radiol 1988; 151: 873–881.

    CAS  Google Scholar 

  122. Namba T, Brunner NG, Grob D. Myasthenia gravis in patients with thymoma, with particular reference to onset after thymectomy. Medicine l978; 57: 411–433.

    Google Scholar 

  123. Younger DS, Braun NMT, Jaretzki A III, Penn AS, Lovelace AE. Myasthenia gravis: determinants for independent ventilation after transsternal thymectomy. Neurology 1984; 34: 336–340.

    Article  PubMed  CAS  Google Scholar 

  124. Mayer SA. Intensive care of the myasthenbic patient. Neurology 1997; 48: S70–S81.

    Article  Google Scholar 

  125. Jaretzki A III, Penn AS, Rowland LP, Sanborn K, Hyman A. Thymectomy for myasthenia gravis: a guideline for pre-and post-operative care. 1987. Available from Myasthenia Gravis Foundation of America, Inc., 5841 Cedar Lake Road (Suite 204), Minneapolis, MN-55416.

    Google Scholar 

  126. Miller RG, Rosenberg JA, Force APPT. Care of patient with ALS: report of the Quality Standards Subcommittee of the AAN. Neurology 1999; 52: 1311–1323.

    Article  PubMed  CAS  Google Scholar 

  127. Kirklin JW, Blackstone EH. Clinical studies with nonrandomly assigned treatment. In: Kirklin JW, Barrett-Boyes BG, eds. Cardiac Surgery, 2nd ed. New York, Churchill-Livingstone, 1993, pp. 269–270.

    Google Scholar 

  128. Haegerty PJ, Zeger SL. Marginal regression models for clustered ordinal measurements. J Am Stat Assoc 1996; 91: 1024–1036.

    Article  Google Scholar 

  129. Wolfe GI, Herbelin L, Nations SP, et al. Myasthenia gravis activities of daily living profile. Neurology 1999; 52: 1487–1489.

    Article  PubMed  CAS  Google Scholar 

  130. Jaeschke R, Guyatt GH. How to develop and validate a new quality of life instrument. In: Spilker B, ed. Quality of Life Assessments in Clinical Trials. New York, Raven, 1990, pp. 47–57.

    Google Scholar 

  131. Ashour MH, Jain SK, Kattan KM, et al. Maximal thymectomy for myasthenia gravis. Eur J Cardiothorac Surg 1995; 9: 461–464.

    Article  PubMed  CAS  Google Scholar 

  132. Emeryk B, Strugalska MH. Evaluation of results of thymectomy in myasthenia gravis. J Neurol 1976; 211: 155–168.

    Article  PubMed  CAS  Google Scholar 

  133. Hayat G, Mohyuddin YA, Naunheim K. Efficacy of thymectomy in myasthenia gravis. Miss Med 1995; 92: 252–257.

    CAS  Google Scholar 

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Jaretzki, A. (2003). Thymectomy. In: Kaminski, H.J. (eds) Myasthenia Gravis and Related Disorders. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-341-5_11

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  • DOI: https://doi.org/10.1007/978-1-59259-341-5_11

  • Publisher Name: Humana Press, Totowa, NJ

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