Since 1967, transcervical
thymectomy has been the procedure of choice for all patients with nonthymomatous
myasthenia gravis and a selected group of patients with thymomatous
myasthenia gravis operated upon at the Mount Sinai Hospital. A total of 180 transcervical
thymectomies have been performed. In 12 patients, a pre-existing
tracheostomy was present. Morbidity was minimal, limited to three instances of
bleeding, five of
pneumothorax, one of self-limited
chylothorax, and one
wound infection. One postoperative death from an unrelated cause occurred in 1967. The postoperative course has been smoother and the management of the
myasthenia gravis considerably easier than those following transthoracic approaches. Consequently, routine elective
tracheostomy at the time of
thymectomy has been abandoned. The average period of hospitalization does not exceed one week. As a result of the minimal risk involved, indications for
thymectomy now include all patients with
generalized myasthenia gravis, and the procedure is performed earlier in the course of disease. Postoperative electromyographic findings show immediate improvement in the majority of patients operated upon during the first year in which symptoms occur. Transcervical
thymectomy arrests the progress of the disease, decreases the mortality rate, and has long term results equal to those of transthoracic approaches. Earlier remissions, fewer germinal centers, and a smaller number of
thymomas were noted in patients operated upon early in the course of the disease. A decrease in
neoplasms outside the thymus gland and in
neonatal myasthenia gravis was also noted following
thymectomy.