Gerald Musa
@eng.rudn.ru
Neurological diseases and Neurosurgery
Peoples' Friendship University of Russia (RUDN University)
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Manuel De Jesus Encarnacion Ramirez, Nicola Montemurro, Gerald Musa, Gennady E. Chmutin, Renat Nurmukhametov, Andreina Rosario Rosario, Jesus Lafuente Barza, Stanislav Kaprovoy, Nikolay Konovalov, Dmitry Kudriavtsev,et al.
Scientific Scholar
Background: Neurosurgery is one of the most complex and challenging areas of medicine, and it requires an ongoing commitment to education and expertise. Preparing young neurosurgeons with comprehensive education that can allow them to achieve high professional standards is a pivotal aspect of our profession. Methods: This paper aims to analyze the current scenario in neurosurgical training identifying innovative methods that can guarantee the highest level of proficiency in our specialty. Results: Given the inherent high-stakes nature of neurosurgical procedures, there is a significant burden of responsibility in ensuring that neurosurgical training is of the highest caliber, capable of producing practitioners who possess not just theoretical knowledge but also practical skills and well-tuned judgment. Conclusion: Providing high-quality training is one of the major challenges that the neurosurgical community has to face nowadays, especially in low- and middle-income countries; one of the main issues to implementing neurosurgery worldwide is that the majority of African countries and many areas in Southeast Asia still have few neurosurgeons who encounter enormous daily difficulties to guarantee the appropriate neurosurgical care to their population.
Gerald Musa, Medetbek Dzhumabekovich Abakirov, Gennady E. Chmutin, Samat Temirbekovich Mamyrbaev, Manuel De Jesus Encarnacion Ramirez, Kachinga Sichizya, Alexander V. Kim, Gennady I. Antonov, Egor G. Chmutin, Dmitri V. Hovrin,et al.
Medknow
ABSTRACT Background: The management of recurrent lumbar disc herniation (rLDH) lacks a consensus. Consequently, the choice between repeat microdiscectomy (MD) without fusion, discectomy with fusion, or endoscopic discectomy without fusion typically hinges on the surgeon’s expertise. This study conducts a comparative analysis of postoperative outcomes among these three techniques and proposes a straightforward classification system for rLDH aimed at optimizing management. Patients and Methods: We examined the patients treated for rLDH at our institution. Based on the presence of facet resection, Modic-2 changes, and segmental instability, they patients were categorized into three groups: Types I, II, and III rLDH managed by repeat MD without fusion, MD with transforaminal lumbar interbody fusion (TLIF) (MD + TLIF), and transforaminal endoscopic discectomy (TFED), respectively. Results: A total of 127 patients were included: 52 underwent MD + TLIF, 50 underwent MD alone, and 25 underwent TFED. Recurrence rates were 20%, 12%, and 0% for MD alone, TFED, and MD + TLIF, respectively. A facetectomy exceeding 75% correlated with an 84.6% recurrence risk, while segmental instability correlated with a 100% recurrence rate. Modic-2 changes were identified in 86.7% and 100% of patients experiencing recurrence following MD and TFED, respectively. TFED exhibited the lowest risk of durotomy (4%), the shortest operative time (70.80 ± 16.5), the least blood loss (33.60 ± 8.1), and the most favorable Visual Analog Scale score, and Oswestry Disability Index quality of life assessment at 2 years. No statistically significant differences were observed in these parameters between MD alone and MD + TLIF. Based on this analysis, a novel classification system for recurrent disc herniation was proposed. Conclusion: In young patients without segmental instability, prior facetectomy, and Modic-2 changes, TFED was available should take precedence over repeat MD alone. However, for patients with segmental instability, MD + TLIF is recommended. The suggested classification system has the potential to enhance patient selection and overall outcomes.
G. Musa, R.E. B. Castillo, D.T. K. Ndandja, B. M. Mwela, G. E. Chmutin, G. I. Antonov, and M. V. Slabov
Publishing House ABV Press
Degenerative disc disease and facet joint disease involving the lumbar spine are common in the aging population and are the most frequent causes of disability. Surgical interbody fusion of degenerative levels is the most common management technique. This is an effective treatment option to stabilize the spine and reduce mechanical pain and provides indirect decompression of the neural elements while restoring lordosis and correcting the deformity. Depending on the direction of the approach to the vertebral column, various techniques have been described. Anterior lumbar interbody fusion (ALIF) offers clear and wide visualization of the disc allowing the use of large interbody grafts, which provide a significant biomechanical advantage over other types of fusion. The transperitoneal approach is a much older technique and it is not commonly performed unless in isolated cases with extensive retroperitoneal scaring following multiple abdominal surgeries. The transperitoneal approach has been associated with higher rates of bowel injury, ileus, and retrograde ejaculation, and is limited at the L5–S1 segment, hence many spine surgeons favor a retroperitoneal approach. The major setback of ALIF is the need for great vessel mobilization. This manipulation of the vessels may lead to deep vein thrombosis and a direct vascular injury. This makes vascular anatomy studies in the preoperative stage invaluable in avoiding vascular injury. Other complications include possible injury to intraperitoneal and retroperitoneal organs, especially in patients with previous surgery and adhesions. Manipulation of the intestines causes postoperative ileus which lasts a few days. Sexual dysfunction in form of retrograde ejaculation is another complication seen in patients following ALIF and this has been attributed to injury to the superior hypogastric sympathetic nerves in the lower lumbar region.This article reviews the ALIF procedure i. e., transperitoneal and retroperitoneal approaches, and the associated intraoperative, early, and late complications.
Serik Kaliulovich Makirov, Gerald Musa, Dimitri T. Keri Ndandja, Gennady Egorovich Chmutin, Alexander Valeryevich Kim, Dmitri Vladimirovich Hovrin, and Olzhas Bekenovich Otarov
Association of Spine Surgeons
Objective. To conduct a literature review of studies comparing the treatment of recurrent lumbar disc herniation using discectomy and spinal fusion.Material and Methods. A comprehensive search across four electronic databases (PubMed, Google Scholar, Science Direct, and Cochrane) was conducted. Studies comparing the outcomes of discectomy and spinal fusion for recurrent lumbar disc herniation were analyzed. Postoperative complications, cost and duration of surgery, length of hospital stay, pain score, and recurrence rate were compared.Results. Ten studies comprising data of 1066 patients met the inclusion criteria. Discectomy was performed in 620 of them, while 446 patients underwent spinal fusion surgery. Discectomy yielded good results in VAS scores for leg and back pain, but after 3–6 months, there was no significant difference compared to spinal fusion. The recurrence rate for discectomy varied from 7.27 % to 22.91 %, while fusion had 0 % same-level recurrence. Fusion surgery had fewer complications: 1.72–28.00 % (average 11.6 %) vs 5.25–32.73 % (average 15.7 %) for discectomy. However, spinal fusion had longer operation time, greater blood loss and longer hospital stay compared to discectomy.Conclusion. Discectomy and spinal fusion are effective treatment options for recurrent lumbar disc herniation. At the same time, discectomy demonstrates a high level of initial relief of symptoms and is more cost-effective. However, the risk of recurrence is significant, and the progression of degeneration and instability may result in pain recurrence within a year. Fusion surgery provides stability and eliminates the risk of recurrence, but the main challenge is the cost of surgery. The choice of technique should be based on individual patient factors, and the advantages and disadvantages of each approach should be carefully considered.
Dimitri T. K. Ndandja, Gerald Musa, Ilya Nosov, Gennady E. Chmutin, Matvey I. Livshitz, Nazar S. Annanepesov, and Bupe Mumba Mwela
Scientific Scholar
Background: Brainstem cavernomas (BSCs) are relatively rare intracranial vascular lesions that, if left untreated, can be devastating to the patient. The lesions are associated with a myriad of symptoms, depending on their size and location. However, medullary lesions present acutely with cardiorespiratory dysfunction. We present the case of a 5-month-old child with a BSC. Case Description: A 5-month-old child presented for the 2nd time with sudden respiratory distress and excessive salivation. On the first presentation, brain magnetic resonance imaging (MRI) showed a 13 × 12 × 14 mm cavernoma at the pontomedullary junction. She was managed conservatively but presented 3 months later with tetraparesis, bulbar palsy, and severe respiratory distress. A repeat MRI showed enlargement of the cavernoma to 27 × 28 × 26 mm with hemorrhage in different stages. After hemodynamic stabilization, complete cavernoma resection was performed through the telovelar approach with neuromonitoring. Postoperatively, the child recovered motor function, but the bulbar syndrome persisted with hypersalivation. She was discharged on day 55 with a tracheostomy. Conclusion: BSCs are rare lesions that are associated with severe neurological deficits due to the compactness of important cranial nerve nuclei and other tracts in the brainstem. Early surgical excision and hematoma evacuation for superficially presenting lesions can be lifesaving. However, the risk of postoperative neurological deficits is still a major concern in these patients.
Gerald Musa, Rossi E.C Barrientos, Serik K. Makirov, Gennady E. Chmutin, Gennady I. Antonov, Alexander V. Kim, and Olzhas Otarov
Scientific Scholar
Background: Recurrent disc herniations remain a challenge in spinal surgery. Although some authors recommend a repeat discectomy, others offer more invasive secondary fusions. Here, we reviewed the literature (2017–2022) regarding the safety/efficacy of treating recurrent disc herniations with repeated discectomy alone. Methods: Our literature search of recurrent lumbar disc herniations included; Medline, PubMed, Google scholar, and the Cochrane database. We focused on the types of discectomy performed, perioperative morbidity, costs, length of surgery, pain scores, and incidence of secondary dural tears. Results: We identified 769 cases that included 126 microdiscectomies, and 643 endoscopic discectomies. Rates of disc recurrence ranged from 1% to 25% with accompanying secondary durotomy varying from 2% to 15%. In addition, operative times were relatively short, ranging from 29.2 min to 125 min, with a relatively small average estimated blood loss (i.e., minimal to maximally 150 mls). Conclusion: Repeated discectomy was the most commonly performed treatment for same-level recurrent disc herniations. Despite minimal intraoperative blood loss and short operating times, there was a significant risk of durotomy. Notably, patients must be informed that more extensive bone removal for treating recurrent disc increases the risk for instability warranting subsequent fusion.
Gennady E Chmutin, Gayrat M Kariev, Rano O Ismailova, Hanifa M Khalimova, Gerald Musa, Adam Majer, and Boris E Oleinikov
Loki & Dimas
The incidence of bulbar syndrome in craniovertebral junction anomalies is between 12% and 35%. Although the use of evoked potentials intraoperatively and preoperatively has advanced in recent years, their use in predicting the development of neurological deficits remains a challenge. This research explores the predictive significance of evoked potentials in the diagnosis of bulbar syndrome in Chiari 1 anomaly. Data from 39 patients and 30 controls were reviewed. Standard multimodal neurophysiological investigations including Brainstem auditory evoked potentials (BAEPs), somatosensory evoked potentials (SSEPs), Nerve Conduction Studies (NCS), and Electromyogram (EMG) were performed. All studies were conducted on the 4-channel complex “Synapsis” (Neurotech, Russia) with computer data processing. The threshold Nerve conduction velocity (NCV) value was 21.5 m/s. The sensitivity and specificity were 75.5% and 71.2% respectively. The area under the ROC curve (AUC) was 0.96±0.36 (95% CI: 0.89-1.00) and p-value 0.004. The M-response amplitude threshold dividing the study group into high and low-risk groups was 1.01 microV. The sensitivity and specificity were 78.0 and 71.2%, respectively. The BAEPs interpeak intervals III-V and I-V were significantly prolonged (P˂ 0.05). SSEPs showed a decreased amplitude and reduced NCV (P ˂ 0.01). Glossopharyngeal nerve electroneuromyography is the most informative test. A decrease in M-response amplitude of bulbar muscles and NCV on efferent fibers is highly predictive of the development of bulbar disorders in patients with Chiari 1, even in subclinical cases.
I. Matvey Livshits, B. Farkhad Berdinov, Gerald Musa, E. Gennady Chmutin, V. Alexander Levov, G. Kirill Chmutin, and U. Zokirzhon Zokhidov
Springer Science and Business Media LLC
Dmitri V Hovrin, Ilya V Senko, Gerald Musa, Dimitri KT Ndandja, Rossi EB Castillo, and Gennady E Chmutin
Loki & Dimas
Cerebral vascular anatomical variations are not uncommon in the human population. Their prevalence is not exactly known, as most of them are incidentally diagnosed on angiography or postmortem dissections. We present a rare fenestration of the A1 segment of the anterior cerebral artery presenting with a ruptured saccular aneurysm. A 42-year-old hypertensive patient presented unconscious following a ruptured saccular aneurysm. The computer tomography angiography showed a fenestration of the right A1 segment of the anterior cerebral artery (ACA). The medial segment of the A1 was communicating with the left ACA via the Anterior communicating artery, while the lateral segment was directly joining the A2 segment of the same side. Intraoperatively, the two segments were identified as separate vascular structures not sharing adventitia, and of equal caliber. The aneurysm arising from the bifurcation was clipped. The patient recovered with no neurological deficits. Many vascular anomalies like fenestrations and bifurcations are underdiagnosed, as many of them remain asymptomatic and are discovered incidentally on postmortem dissection or angiography for other pathologies. This has led to a paucity of cases to determine the prevalence in the human population. Good knowledge of the vascular anatomy variations and associated risk of aneurysm is important for the vascular neurosurgeons.
Semyon A. Melchenko, Vasiliy A. Cherekaev, Olga Yu. Alyoshkina, Gleb V. Danilov, Gerald Musa, Uliya V. Strunina, Denis A. Golbin, Nikolay V. Lasunin, and Alexander A. Zaychenko
Springer Science and Business Media LLC
Kamaliddin Djumanov, Gayrat Kariev, Gennady Chmutin, Gennady Antonov, Egor Chmutin, Gerald Musa, Adam Maier, and Alina Shumadalova
Frontiers Media SA
ObjectivesSpinal tumors remain a challenging problem in modern neurosurgery. The high rate of postoperative morbidity associated with intramedullary tumors makes the need for safer surgical techniques invaluable. This study analyses our experience with the treatment of spinal cord tumors and compares traditional management and a new different surgical approach to intramedullary tumors with an associated hydrosyringomyelia.Materials and MethodsThis retrospective study compared standard surgical techniques and 2 newer modified techniques for intra and extramedullary spinal tumors at the Neurosurgery center for spinal cord tumors of the Republic of Uzbekistan. Preoperative neurological status was recorded with the ASIA/ISNCSCI scale. Postoperative outcome was graded using the Nurrick score.ResultsOf the 280 cases, there were 220 (78.5%) extramedullary and 60 (21.5%) with intramedullary spinal tumors. The control and main group had 159 (56.8%) and 121 (43.2%) patients, respectively. Severe compression myelopathy (ASIA- A, B, C) was 217 (77.5%) patients i.e., ASIA A-39 (13.9%); B-74 (26.4%), and C-104 (37.1%). In 74 extramedullary tumors (33.6%) treated with the new method, good postoperative outcomes in 44 cases (59.5%) with OR = 1.9; 95% CI 1.1–3.3 (p < 0.05). Thirty-seven (61.7%) intramedullary tumors were treated with the newer modified technique. There was no difference with the standard method (p = 0.15). However, when comparing postoperative Nurick grade 1–2 with grade 3–4, the newer strategy was superior with improvement in 24 (65%) patients, OR = 3.46; 95% CI 1.2–10.3 (p < 0.05).ConclusionWhen compared with standard methods, the proposed newer modified strategy of surgical treatment of spinal cord tumors with the insertion of a syringosubarachnoid shunt in the presence of an associated hydrosyringomyelia is associated with better postoperative outcome (Nurick 1 and 2) in 64.8%.
Ilya O. Nosov, Alexei N. Kislyakov, Matvey I. Livshits, Pavel V. Lobankin, Gennady E. Chmutin, and Gerald Musa
Scientific Scholar
Background: Neuroenteric cysts are rare cystic benign neoplasms of the central nervous system most often located in the spinal cord and rarely, intracranially. The nonspecific neuroimaging features make management planning potentially challenging. We present a case of a radiologically misdiagnosed neurenteric cyst with a complicated course. Case Description: A 13-year-old girl presented with a 6-month history of headache, tinnitus, and dizziness. Initial magnetic resonance images (MRIs) were indistinguishable from a pineal arachnoid cyst with aqueductal stenosis and hydrocephalus. Cyst fenestration was performed through an infratentorial supracerebellar approach. Histology revealed a neurenteric cyst. On day 10 postoperatively, she deteriorated with acute hydrocephalus and cyst enlargement. An external ventricular drain was inserted. She remained asymptomatic thereafter. At 1-year postoperative, the patient remains asymptomatic despite the MRI showing cyst enlargement and local dissemination in the form of multiple cystic lesions in the cerebellum along the operative corridor. The patient was managed conservatively considering adhesion noted intraoperatively. Conclusion: Neuroimaging features of brain cystic lesions may be nonspecific. Special attention should be awarded to posterior fossa and paramedian cystic lesions. Rarer lesions like neurenteric cysts should also be considered. When in doubt, we recommend using the following methods to prevent the free outflow of the cyst contents into the subarachnoid space: lining the cyst and operative corridor with cotton wool and puncture opening and suctioning of fluid. However, the “gold standard” remains surgical treatment with radical excision of the endodermal cyst capsule. It is necessary to preassess the possibility of total or subtotal resection.
Gerald Musa, Keith Simfukwe, Alexander Gots, Gennady Chmutin, Egor Chmutin, and Bipin Chaurasia
Elsevier BV