Surgical treatment of myasthenia gravis
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Background
• Description • Prevalence • Clinical presentation • Pathophysiology • Treatment
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Early practice in surgery
-- Mayo Clinic group 精品课件
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Thymoma and myasthenia
gravis
Masaoka staging
Histological classific• Indication Thymectomy is recommended for those relatively
healthy patients whose myasthenic symptoms interfere with their lives enough for them to consider undergoing major thoracic surgery. While it is expensive and invasive,thymectomy is the only treatment available that offers a chance of an eventual drug-free remission. This chance seems to be better earlier in the disease than later. The potential benefit of thymectomy also decreases as the adult patient gets older and as the thymus naturally involutes with time. Further, the risk of surgery increases with age. The age at which the risks outweigh the potential benefits must be individualized for every patient
• Time: preoperation evaluation and prepare
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How
• Range of resection • Thymectomy • Extended thymectomy • Maximal thymectomy
• Approach for surgery
• Transcervical • Transpleural • Transsternal
• T-2 Videoscopic Thymectomy (a)- Classic VATS (b)- VATET
• T-3 Transsternal Thymectomy (a)- Standard (b)- Extended
• T-4 Transcervical & Transsternal Thymectomy
treatment
Ernst Ferdinand Sauerbruch (1875 –1951)
Alfred Blalock (1899 –1964)
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Advance in surgical treatment
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MGFA classification of thymectomy
• T-1 Transcervical Thymectomy (a)- Basic (b)- Extended
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Crisis after themectomy
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Reoperation for thymus
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Future of surgical treatment
• “It seems likely that future discoveries will permit the management of myasthenia gravis without surgical intervention but, for the present, the beneficial role of thymectomy for these unfortunate patients has been clearly demonstrated.”