The connection between myasthenia and thymic lesion was originally discovered in 20th century.
Thymectomy is a standard surgery, recommended by the specialists to the patients with moderate to severe miastenia gravis( generalized form of myasthenia).The surgery is also indicated to all patients suspected of having thymoma(benign or malignant neoplasms of thymus).
In the most clinics , transsternal surgical access is used for carring out thymectomy, and the surgical goal is to remove the entire thymus with anterior mediastinal mass.
Patient S.D., 1980y/b was admitted to MC “Erebouni” in 12.01.2016 with complaints of generalised weakness, speech disorder, difficulty in swallowing (disphagia),paralysis of the facial muscles (facoplegia) and dyplopia. The patient considers herself ill since November 2015, when noticed speech disorder, swallowing disorder, paralysis (weakness) of the facial muscles. The condition of the patient has sharply deteriorated in the dynamics: expressed muscle weakness, completely disrupted act of swallowing was added.
After carring out clinical and laboratory tests and instrumental investigations , the patient was diagnosed: Generalized form of myasthenia (myasthenia gravis) in the stage of decompensation, sharply defined thymic hyperplasia .
After appropriate medication therapy the condition of the patient was subcompensated,after which was offered surgical treatment-total thymectomy.
In 10.02.16 under general anesthesia was carried out longitudinal sternotomy by the team of thoracal surgeons headed by The Chief of the Clinic of Thoratic Surgery Prof. A.K. Hovhannisyan (MD.,Phd), with the assistance of the leading surgeons Dr.G.B.Melikyan and Dr. G.S.Soghomonyan.
Medical audits found ,that the thymus gland was hyperplasiated,enlarged and joined with mediastinal layers of pleura from both sides. With acute and blunt methods was performed the removing of thymus from mediastinal layers of pleura, pericardium and anatomical structures of anterior mediastinium, then after clipping and bandaging of thymic vessels was performed total thymectomy.
It was also carried out the removing of anterior mediastinal mass up to diaphragm nerves from both sides. The operation was over by the drainage of anterior mediastinal and the right pleural cavity.
The patient was extubated on the operating table and transferred to ICU (Intensive Care Unit) for the further treatment.
The postoperative period went smoothly. The patient received appropriate medication therapy, and after surgical rehabilitation will continue the treatment in Neurological Department.
It is important to note that such kind of surgeries should be performed in specialized clinics or medical centres with the assistance of highly- professional level of specialists` team :neurologists ,who come across myasthenia gravis(generalized form of myasthenia),and thoratic surgeons. These patients often,in distant terms , receive chemotherapy or radiotherapy after surgery. The entire comlex is important in order to avoid severe complications of thymectomy and for productive completion of the treatment of the patients with such kind of pathologies.
