Multidisciplinary approach of non-thymomatous myastenia gravis

Objectives: Thymectomy has been accepted as a potential therapy for myasthenia gravis in patients with failure of medical treatment. The extent of resection of surrounding mediastinal fat remains contentious, and several approaches have been proposed. Transcervical thymectomy has been criticized as potentially giving a “lesser” thymectomy. We report our multidisciplinary approach to the myasthenia gravis in non thymomatous patients treated with transcervical approach with telescope enhancement. Methods: The technique was used in 7 patients with failure of medical treatment. Preoperative stage according to MGFA classification was 1 and 2. Thymic hyperplasia and Hassal’s corpuscles were found in all patients. All patients show a reduction of symptoms at a mean follow up of 31 months. Conclusions: Patients with myasthenia gravis need a multidisciplinary approach and close follow-up care in cooperation with the primary care physician. Minimally invasive transcervical thymectomy permits to perform a safer thymectomy with an extended removal of all anterior mediastinal fat and good results at midterm follow up.