[Surgical treatment of myasthenia by thymectomy. A report on 248 cases (author's transl)].

Good results were obtained in 80 p. cent of 248 patients seen after more than 15 months following the operation. Results are grouped as a function of the different characteristic features of the patients and three groups can be defined: failures, improvement, remissions. These results contradict those who assert that thymectomy is of no value for severe cases. Cervicotomy is performed for non-tumoral forms or for small tumors; sternotomy is reserved for large median thymomas; anterolateral thoracotomy for laterally located thymomas and tracheotomized patients. Postoperative tracheotomy is very rarely needed. Patients are followed-up by clinical signs and ergodynamometric tracings. The prognosis for the myasthenia is not affected by the presence or absence of germinating centres in the non-tumoral thymus, or by the benign nature of the thymoma. Small undiagnosed tumors may be discovered during operation. Treatment of recurrences is difficult. The myasthenia may be associated with other auto-immune affections. The indication for operation in the purely ocular forms is debatable. Thymectomy may produce total remission even in severe cases, and may improve the results of medical treatment. Even in case of failure it can reduce the severity of the course of the disease.