Thymectomy for myasthenia gravis.

Thymectomy was performed on 31 patients with myasthenia gravis. Four of them had thymoma, 17 hyperplasia and 9 had normal thymic histology on microscopy. Discontinuation of anticholinergic medication together with tracheostomy, artificial ventilation and intensive observation were essential in the postoperative management. All the patients survived operation and were discharged from hospital. Sixty-eight per cent of the patients were in remission or improved after an average follow-up of 2.5 years. If the patients with thymoma were excluded, 74% were improved and, if only the patients with thymic hyperplasia were included in the series, 89% were improved after thymectomy. The severity of disease and duration of symptoms pre-operatively seemed to be of minor importance for the results of operation, since good results were obtained also in patients with a long history and in clinical classes III and IV. Two patients developed tracheal stenosis as a complication of intubation with a tracheostomy tube. Tracheal resection was performed in one of them and endobronchial removal of granulation tissue producing the stenosis in the other. Both recovered uneventfully. One patient, who was asymptomatic and without medication for myasthenia, died suddenly of acute cerebral bleeding 3 years after thymectomy.