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3 The Role of Maximal Thymectomy for Myasthenia Gravis Nezar abas * Abstract Objectives: We purpose to evaluate the role of maximal thymectomy in themanagement of Myasthenia Gravis (MG) and to define the most Important prognostic factors In our experience Patients and Methods: Over the period between we have performed thymectomy for (160) patients with myasthenia Gravis, there were 86 females and 74 males, patient's age was between 8-65 years, median age was 27 years, there were only 5 children, the preoperative duration of symptoms had ranged between 2 months until 8 years, the surgical approach was completed Median sternotomy and the procedure had included maximal thymectomy for all patients, thymomas were combined with MG in 52 patients (325%), lymphoid hyperplasia was confirmed in 100 patients (625%) and regressive thymus in 8 patient (5%) Results: 100 patients were included in the follow -up period which ranged between 3-14 years, the results had been evaluated according to the International criteria founded by Myasthenia Gravis Foundation of America (MGFA) as the following: - Complete Remission (no symptoms, no medications) - 73% - Improvement (less medications, better control of symptoms) - 22% - Failure (more medications, more symptoms) - 5% The most Important unfavorable prognostic factors were: presence of thymoma, Incomplete thymectomy and inadequate preoperative preparation, there was no Relation between prognosis and age, sex and duration of symptoms Conclusion: Maximal thymectomy is the treatment of choice for the vast majority of patients with myasthenia Gravis as soon as the diagnosis was established Key words: Myasthenia Gravis, Thymectomy, Thymoma * Prof of Department of surgery, Faculty of Medicime Damascus University 37

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9 '# +(! M # 9M ( ', '# 9K" K 6/ A# 7) (4) " + ( D +'" 2* K + & C) C! M 3 C' # / '< 3' C'< + * < 3 Isabel PN ieto ' 2 4 K'' + ''&! (12) Masaoka 9(6) C'7 C $> +" 2 )07 G J ' 4 B0 * :(4) G 7 8; 0 N; % 22% 73% - ( 3 6/ ( * \B %!! $! ' '( '/ 9' 950 ' 78 ) G: 12 ) V7 '* C'4( R, A =#! 7) ((5) " + 3 2' ' ' "1 (20) papatestas 9(10) Jaretzki '( '4 R,' A# M I' 9B- A, : B0 * :(5) G 7 8; 0 N;8 950 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ) 20 G: ) ) ) ) 5% 22% 73% 100 V7 43

10 - / 01' ( )* +, + IB! G (6) " ')* +', 8 81% 3 % ' C' :"' 9 3'< +' 3 +, 8,& )( +, 8 14% 4(, 9) $ +, C# = A8 ( C "1 4 A A7)! 4& 4 M C 7 '# '#( 9 + C' +', 8 # C +- ' * KH +?' ( R b-* E 3 $ $ * + ' 9+(! M # K/ 07 )17 )+4 B0 * : (6) G 7 H ) N;8 Jaretzki (10) Transcervical - Transsternal maximal thymectomy % Masaoka (14) Extended Transsternal thymectomy % Kirby and Ginsberg (18) Transcervical thymectomy % Cooper (13) Transcervical thymectomy % Michael Mack (16) Video Assisted thymectomy % 2 \ (% 25) 3' * K ( A +' 01' # E# 0c R ' '4 +', IB' +(??' G? + R, A7)! # J! # A8 +#? ( c R +'# J +, 8 % 3 '#< A'#! 93 * ( +# IB 3! G -O Masaoka (10) Jaretzki 5, '" ' + AB 9(17)Tommaso Mineo 9(12) ' +" % C (37%) &'4( 3' 0 4( 9A 6/ C! 4(, '# 44

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12 - / 01' ( )* +, References 1- Richard F Heitmiller, Engenie S Heitmiller, Surgery for myasthenia Gravis, Advanced therapy in thoracic surgery, 2th edition, BC Decker, 2005, P: Junli and Lisak, pathophysiology of myasthenia Gravis, General thoracic surgery, 6 th edition, LWW, 2005, P: Daniel Drachman, myasthenia Gravis, the New England Journal of Medicine, 1994, vol 330, 25, P: Richard F Heitmiller, myasthenia Gravis: clinical features, pathogenesis, Evaluation and medical management, Seminars in thoracic and cardiovascular surgery, vol 11, No 1, 1999, P: David S Younger, myasthenia Gravis, General thoracic surgery, 6 th edition, LWW, 2005, P: Isabel P Nieto and colleagues, prognostic factors for myasthenia Gravis treated by thymectomy, Annals of thoracic surgery, 1999, vol 67, P: Federico venuta and colleagues, Thymectomy for myasthenia Gravis : a 27 years experience, European Journal of cardio Thoracic surgery, 1999, 15, P: Donald G Mulder and colleagues, thymectomy for myasthenia Gravis: Recent observations and comparison with past Experience, Ann, Thoracic surgery, 1989, 48, P: Nichols and Trastek, standard thymectomy, General thoracic surgery, 6 th edition, LWW, 2005, P: Alfred Jaretzki, Transcervical Transsternal maximal thymectomy, General thoracic surgery, 6 th edition, LWW, 2005, P: Anthony Yim, VATS Approach to the thymus, Minimal Access cardio thoracic surgery, Saunders, 2000, P: Akira Masaoka and colleagues, Extended thymectomy for myasthenia Gravis patients : A 20 year review, Ann of thoracic surgery, 1996, 62, P: JD Cooper and colleagues, An Improved technique to facilitate Transcervical thymectomy for myasthenia Gravis, Ann of thoracic surgery, 1988, 45, P: Akira masaoka, Extended transsternal thymectomy, General thoracic surgery, 6 th edition, LWW, 2005, P:

13 15- Frank C Detterbeck, one Hundred consecutive thymectomies, for myasthenia Gravis, Ann of thoracic surgery, 1996, 62, P: Michael J Mack, Video Assisted thymectomy, General thoracic surgery, 6 th edition, LWW, 2005, P: Tommaso Claudio Mineo and colleagues, video Assisted completion thymectomyin refractory myasthenia Gravis, Thoracic and Cardiovascular surgery, January, 1998, 115, P: Kirby and Ginsberg, Transcervical thymectomy, General thoracic surgery, 6 th edition, LWW, 2005, P: Al fred Jaretzki and Colleagues, maximal thymectomy for myasthenia Gravis, thoracic and cardiovascular surgery, January, 1988, 95, P: Papatestas and Others, Effects of thymectomy in myasthenia Gravis, Ann surgery, 1987, vol 206, N: 1, P: /5/17 : f /2/20 : 5 " f 47