{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T01:05:56Z","timestamp":1755219956481,"version":"3.43.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate a 10-year experience in the surgical treatment of patients with myasthenia gravis, focusing on clinical and pharmacological outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective single-center study was conducted based on prospective data collection from the Redcap\u00ae maintained by the Thoracic Surgery Department in a Brazilian tertiary hospital. Patients with myasthenia gravis (AchR positive), who underwent surgical treatment as an adjuvant to clinical therapy were included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study comprised 85 patients with a mean age of 43\u202fyears; 75% were female. Regarding the type of surgery, 24.7% underwent sternotomy and 75.3% minimally invasive approach. The median hospital stay was 4.0\u202fdays (p25\u202f=\u202f3.0; p75\u202f=\u202f5.5), and the median ICU stay was 1.0\u202fdays (p25\u202f=\u202f0.40, p75\u202f=\u202f2). Postoperative outcomes showed a corticosteroid reduction in 52 participants (61%), and 30 (35%) showed anticholinesterase reduction. The median dose of corticosteroids before surgery was 40.00\u202fmg, and after surgery, 20.00 (<jats:italic>p<\/jats:italic>-value &amp;lt; 0.001). Based on Osserman classification, before surgery, it was observed that 4% had grade I, 15% grade IIa, 32% grade IIb, 31% grade III, and 18% grade IV. After surgery, it was observed that 28.5% were asymptomatic, 28% had grade I, 34% had grade IIa, 3.6% had grade IIb, and 5.9% had grade III. There was no statistical difference in clinical and pharmacological response in the analysis with and without thymoma and myasthenia (<jats:italic>p<\/jats:italic>-value 0.403; <jats:italic>p<\/jats:italic>-value 0.104). About the surgical approach, patients undergoing thymectomy by sternotomy have longer hospital and ICU stays with statistical significance (<jats:italic>p<\/jats:italic>-value &amp;lt;0.001; p-value 0.005).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrated that surgical treatment for myasthenia gravis is safe and effective for symptom control and medication reduction, regardless of the surgical approach, with shorter ICU and hospital stays through the minimally invasive approach.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1595927","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T15:36:07Z","timestamp":1754580967000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical treatment of myasthenia gravis: 10\u202fyears of single center experience"],"prefix":"10.3389","volume":"16","author":[{"given":"Jos\u00e9 De S\u00e1","family":"Moraes Neto","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaqueline Schaparini","family":"Fonini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"De Assis Cavalcanti Neto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda Aquino","family":"De Oliveira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel Lunardi","family":"Aranha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio Alberto","family":"Zambon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo De Paula","family":"Estephan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edmar","family":"Zanoteli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulo Manuel","family":"P\u00eago-Fernandes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro Wasum","family":"Mariani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.medcli.2023.04.006","article-title":"Myasthenia gravis. Update on diagnosis and therapy","volume":"161","author":"Garc\u00eda Est\u00e9vez","year":"2023","journal-title":"Med Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.3390\/jcm10112235","article-title":"Myasthenia Gravis: Epidemiology, Pathophysiology and Clinical Manifestations","volume":"10","author":"Dresser","year":"2021","journal-title":"J Clin Med."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1212\/WNL.48.Suppl_5.52S","article-title":"\u2018\u201cMaximal\u201d\u2019 thymectomy for myasthenia gravis. 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Anais de Congresso - SPPT\/SBPT","year":"2019","author":"Mariani","key":"ref10"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e37584","DOI":"10.7759\/cureus.37584","article-title":"Effect of thymectomy on outcomes of myasthenia gravis patients: a case-control study at a tertiary care hospital","volume":"15","author":"Khawaja","year":"2023","journal-title":"Cureus"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1007\/s00464-003-9146-1","article-title":"Comparison between the right side and subxiphoid bilateral approaches in performing video-assisted thoracoscopic extended thymectomy for myasthenia gravis","volume":"18","author":"Hsu","year":"2004","journal-title":"Surg Endosc"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1016\/s0003-4975(96)00376-1","article-title":"Extended thymectomy for myasthenia gravis patients: a 20-year review","volume":"62","author":"Masaoka","year":"1996","journal-title":"Ann Thorac Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1016\/j.ejcts.2009.11.029","article-title":"Comparison of complete remission rates after 5 year follow-up of three different techniques of thymectomy for myasthenia gravis","volume":"37","author":"Zielinski","year":"2010","journal-title":"Eur J Cardiothorac Surg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1510\/icvts.2010.251041","article-title":"Video-assisted thoracoscopic surgery or transsternal thymectomy in the treatment of myasthenia gravis?","volume":"12","author":"Zahid","year":"2011","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1212\/wnl.55.1.7","article-title":"Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review) [RETIRED]: report of the Quality Standards Subcommittee of the American Academy of Neurology","volume":"55","author":"Gronseth","year":"2000","journal-title":"Neurology"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1595927\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T15:36:08Z","timestamp":1754580968000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1595927\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,7]]},"references-count":16,"alternative-id":["10.3389\/fneur.2025.1595927"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1595927","relation":{},"ISSN":["1664-2295"],"issn-type":[{"type":"electronic","value":"1664-2295"}],"subject":[],"published":{"date-parts":[[2025,8,7]]},"article-number":"1595927"}}