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Member since Jun-04-08 · Last seen Feb-19-17
Good Day to All! Ma-ayong adlaw sa tanan. And my thanks to for this excellent website. Salamat Opinions:

1. World Chess Championship

The true Chess World Champions are the holders of the Traditional Title that originated with Steinitz & passed on in faithful succession to Lasker, Capablanca, Alekhine, Euwe, Botvinnik, Smyslov, Tal, Petrosian, Spassky, Fischer, Karpov, Kasparov, Kramnik, Anand, and Carlsen. The sacredness of this Title is what makes it so valuable.

And how does one become the true Chess World Champion? In general, by beating the previous Titleholder one on one in a Match! Matches are preferred over Tournaments because of the Tradition of the WC Succession & because the chance for pre-arranging a Tournament result is more likely. The only exceptions to this rule:

A. In case where the Candidates and World Champion participate in an event that all the participants agree to be a World Championship event because of extraordinary circumstances.

Thus, the 1948 World Championship Tournament was justifiable because of the death of the Title holder Alekhine.

Likewise, the 2007 WC Tournament was justifiable under the extraordinary circumstances of the Chessworld trying to heal its internal rift over the 1993 Kasparov Schism. Anand himself became the World Champion in this 2007 Tournament & not in 2000 when he won a knock-out FIDE Tournament. Caveat: Some chess fans deem the 2007 WC Tournament as illegitimate, considering that Anand became the World Champion only in 2008, when he beat the previous Titleholder Kramnik in a WC match. From this perspective Anand only became the Undisputed World Champion in 2008.

Karpov lost his Title to Kasparov in 1985, & never regained it in the 1990s events that FIDE labeled as 'world championships'. All solely FIDE Champions that emerged outside WC Traditional Succession elaborated on above, strong as they were, were not true World Champions (eg., Bogolyubov 1928, Khalifman 1999, Ponomariov 2002, Kasimdzhanov 2004, Topalov 2005).//

B. In case the previous Titleholder defaults an event that the Chessworld largely deems as a World Championship event in the Tradition of the World Championship Succession. Thus, Karpov was the true successor to Fischer who defaulted their WC Match in 1975.

2. The strongest chess events in different eras of chess history?

Because of the brain's limitations explained below, the best professional (amateurs don't matter much in top level chess) chess players of each generation beginning in the Lasker era have always played at a similar level - near the maximum allowed by human standards. Now there are larger cohorts of chess professionals post WW2 than preWW2 thanks to government state funding in the Soviet era and presently corporate funding. The result is that large preWW2 tournaments had numerous 'bunnies', relatively weak players. By the Kasparov era, super-tournaments that featured most of the top ten, and no bunnies, had became more common. However, the top 4 or 5 since Lasker's time have always been very strong.

Consequently the smaller the top-player-only tournament, the stronger it gets. For any era. If there was a double round robin tournament in 1914 featuring Lasker, Capablanca, Alekhine, and Rubinstein, and no other, it would be as strong as any present day super-tournament.

Now weed out everyone except the two strongest players in the world. What we (usually) get is the chess World Championship match.

There has been talk of elite tournaments, composed only of the strongest top masters and no weaker bunnies replacing the World Championship match in prestige, probably because of the assumption that they would be the strongest chess events possible. False assumption. The strongest chess events in chess history generally have been World Championship matches. Even the strongest masters in each generation usually do not match the world champion and challenger in chess strength. In a World Championship match, the contestant has to meet the monster champion or challenger over and over again, with no weaker master in between. Capablanca vs Lasker 1921 was just as strong a chess event as the recent Carlsen vs Anand 2013, and far stronger than Zurich 2014. (Imagine having to play 14 straight games with a computer-like errorless Capablanca at his peak.)

3. The strongest chess players in chess history?

IMO the 1919 version of Capablanca & the 1971 version of Fischer, both of whom played practically error-free chess, are it; updated in opening theory, they should beat anyone in a match.

If computers were self-aware, I have no doubt that they would unanimously choose the 1916 to 1924 Capablanca as the strongest chess player in history. And please no red herring remark that Capa played only 'simple' chess. This young Capablanca played some of the most complicated, sharp, double edged, and bizarre positions possible; and played them without making a single losing error (and by all accounts with unsurpassed quickness), something that has always befuddled my mind when I got to peruse through his games.

We have to take this question in the context of the limits of the human Anatomy and Physiology. A concrete example would be the one hundred meter dash. The human body is designed such that the limit it can run is about 9 seconds. In order for a human being to run faster, we would have to redesign the human anatomy into that of say a cheetah. One can rev up the human Anatomy and Physiology, say with steroids, but this regimen would hit an eventual Stonewall too; the same way that we could rev up human proficiency to learn openings with computer assistance.

Since the Nervous System has physiological limits (example of a limit- neuronal action potential speed don't go up much more than 100 m/s) and so limits the human chess playing ability, increasing the number human chess players, thus expanding the normal curve of players, simply creates more possibilities of players playing like a Fischer in his prime, but will not create a mental superman who plays chess at computer levels. This explains why human and computer analysis indicate that Lasker was playing on a qualitatively similar level as more recent WCs.

'Worse' in chess, any computer assistance ends once the opening is over. After a computer-assisted opening prep, every GM today has to play the game the way Lasker did a hundred years ago, relying on himself alone, with the same fundamental chess rules and chess clock. An Encyclopedic opening repertoire is not a necessity to be a top player. In fact, there are World Champions who did not do deep opening prep; they just played quiet but sound openings that got them into playable middlegames and then beat their opponents in the midlegame or endgame. Just look at Capablanca, Spassky, Karpov, and now Carlsen.

Because of subconscious adherence to the narcissistic generation syndrome, the belief that everything that is the best can only exist in the here and now, many kibitzers would not agree to the above theses. While it is true that there have been more active chess professionals and consequently larger cohorts of top chess masters on a yearly basis since WW2 thanks to Soviet state funding and present corporate funding, the very top chess masters since Lasker's time have always played at a similar level- within the limits imposed by the human brain. There is no physical law that bars a pre-WW2 chess master from playing chess as well as today's generation. The human brain has not changed in any fundamental manner in the past tens of thousands of years.

4. The greatest chess players in history?

A related question is who is the greatest chess player in history. The answer depends on the criteria one uses. Since I place great emphasis on the ability to play world class chess for the longest period of time, Lasker would be it. He was playing at peak form from 1890 age 22 (when he began a remarkable run of match victories over Bird, Mieses, Blackburne, Showalter, and culminating in his two massacres of Steinitz) until 1925 at age 57 (when he nearly won Moscow after winning new York 1924). Kasparov (high plateau from 1980 to 2005) and Karpov (high plateau from 1972 to 1996) would follow. (At their very peak though, I believe that Kasparov was stronger than Karpov, and both were stronger than Lasker; and the peak Capablanca and Fischer were stronger than any of them.)

5. Computers vs Humans, who is stronger?

Another related question is how history's top masters would fare against computers. It's obvious from Kasparov's time that computers would totally crush them all. Opening knowledge would not matter much. Computers swamp human opponents in the middle game, simply by calculating more variations more rapidly by several orders of magnitude. Peak Capablanca probably would have the best score among humans. Talk about another level of playing is fans' subjective and IMO wrong words for their favorite players, unless one talks about chess computers. Chess computers do play at a higher level.

6. On the game and chess players young and old, past and present:

The proposition that an older player would not be able to adjust to the openings and methods of a younger generation is false, as evidenced by the observation of strong masters whose careers happened to span generations beating the tar out of weaker masters of the next generations. Lasker provides a classic example; he was beating Mieses, Blackburne, and Steinitz in the 1890s, and crushing masters versed in the hyper-modern teaching of controlling the center indirectly- Reti, Bogolyubov, and Euwe in the 1920s. In more recent times, we have Victor the Terrible, who learned most of his chess in the 1940s and 1950s, whom we have seen competing successfully with the so-called computer generation even at an advanced age.

This 'inter generational knowledge/theory leveling phenomenon' holds true today and will probably still hold true two decades from now. As of the end of 2015, Kramnik, Anand and Topalov, and a couple of years ago Gelfand are living smoking gun proofs that the speculation that the older generation cannot adopt to newer openings is false. Older players have always adapted and will always adapt to the latest openings in the vogue. The present day young players will do the same 20 years from now, faced with a future generation of rising chess players.

The notion that computers are more advantageous to younger players IMO is not quite right. Younger players should have more energy and stamina in studying chess openings and endgames for long hours everyday compared to older players without computers, but the use of computers would tend to make the learning process easier for every one including the older ones.

As a corollary, computers also make it easier today for very young players in their early teens to peak at a younger age than in past eras, although they tend to level off in their early 20s to their high plateau, defined by their inborn talents and determination.

In brief. computers tend to level chess learning for everyone, young and old.

This is not a rigid rule. The best games I have ever seen played by a 12-13 year old are Capablanca's; and Tal, Karpov, and Kasparov reached their high plateau in their early 20s in a computer-less era, similar to computer age Carlsen. However let it be noted that Carlsen reached his peak sidestepping intensive computer-prepped tactical openings and beating his competitors in the old fashioned way in the middlegame and endgame. These masters peaked early not because of computers by because of their immense chess talent. Perhaps normal rules do not apply to these geniuses.

Another false notion is that the nature of the middlegame today is somehow different from the middlegame in the past. The easiest way to prove the wrongness of this proposition is by observing CG's daily puzzles. Do not peek at the names of the players that played these puzzles, and don't look at the dates. Can you glean from the middlegame play and combinations in the puzzles the date they were played? You can't. You would not know if it was played in 2016, 2000, 1950, or 1900. Chess combinations don't just suddenly change their stripes just because a hundred years have passed.

Another observation is that when the best masters of the past, Lasker, Capablanca, and Alekhine met the occasional 'modern' structures of the Sicilian Scheveningen and Dragon, KID, Modern Benoni, Benko Gambit, they played strategically perfectly, in just the way these opening structures should be played. So how did these masters play openings and the resulting middlegame structures that are deemed incomprehensible to them by some of today's dogmatically 'modern' kibitzers? The answer is that chess rules and principles have not changed. Center, rapid development, open files and diagonals, holes, weak pawns, piece activity, initiative and attack, positional sacrifices and all types of combinations were as familiar to them as to us.

Note that it is the frequencies of a few middlegame pawn structures that have changed since WW2. Not the Ruy Lopez or QGD, but obviously Sicilians and KIDs are much more common post-WW2. Since so many games nowadays begin with the Sicilian and KID, people associate these with being 'modern' (which is a rather vague undefined term IMO). But certainly Lasker and Capablanca understood the middlegame principles behind them and when they did get these positions they played them excellently, like the top masters they are.

Moreover, Keres is another smoking gun, bomb proof evidence of the fallacy of Watson's speculation that 'the best players of old were weaker and more dogmatic than the best players today', and Larsen's assertion that he would crush everyone in the 1920s. The glaring fact is that Keres is a pre-WW2 master who began his career in the late 1920s, and played competitively up to the 1970s, and he did learn (and contributed) to the newer opening variations (the most famous of which is the Keres attack which he invented in 1943). The ideal way for Watson and Larsen to prove their statements is to beat a top pre WW2 master such as Keres. They failed. Tellingly enough an aging Keres beat both a rising Watson and a peak Larsen when they happened play each other.

7. On ratings:

Elo ratings reflect relative and not absolute chess strength.

Chessplayers are naturally arranged in populations partitioned by geopolitical regions & time periods that have infrequent contacts with one another. Within such a population, players get to play each other more frequently, thus forming a quasi-equilibrium group wherein individual ratings would tend to equilibrate quickly; but not with outside groups. With caveats & in the proper context, FIDE/Elo ratings are simply fallible descriptors & predictors of an active player's near-past & near-future performances against other rated players, & only within the same quasi-equilibrium group.

As corollaries: the best way to evaluate a player's strength is to analyze his games & not his ratings; one cannot use ratings to accurately compare the quality of play of players from the past and present, or even the same player say a decade ago and today; & care should be taken in the use of ratings as a criterion in choosing which players to seed into the upper levels of the WC cycle. All the above often entail comparisons between players from different quasi-equilibrium groups separated by space and/or time.

Regarding inflation deniers, they imply that Elo ratings reflect absolute and not relative chess strength. Professor Elo himself would condemn their view. If the top 20 players were to suffer a serious brain injury and begin playing like patzers, but play no one else for the next decade, they would more or less retain their 2700s ratings, although they would be playing terrible patzerish chess.

8. Best Qualifiers?

The credible, fair, tried & tested Zonals - Interzonals - Candidates (with known strong players directly seeded into the Interzonals & Candidates; & here ratings may be used with caveats) over the random World Cup and the elitist Grand Prix. If possible long Candidate matches and 16 to 24 game World Championship matches. However, with the passing of the state-funded chess era of Soviet times, I begin to doubt if the strict money guzzling qualification process above can be re-installed.

9. The 1993 Chess Rift and Kramnik:

Regarding the Rift in the chessworld after Kasparov split in 1993, I believe that Kramnik has done more than any other individual in helping heal it by concrete actions - agreeing to a WC Match with Topalov in 2006 & not walking out when he could have done so with the support of most of the world's top GMs after getting accused of cheating; & agreeing to Defend his Title in a WC Tournament in 2007, the first time a living Titleholder has agreed to do so in chess history. My eternal gratitude to him.

10. Finances of a would-be Challenger:

Regarding all kinds of problems chessplayers outside of Europe & the USA face in their quest for the Title, Capablanca & Anand have proven it's possible for a non-European non-USA chessplayer to be World Champion; but apparently only if you have the chess talent of a Capablanca or Anand! For others, I guess they would have to try to get monetary support & good seconds somewhere to have some hope for a Title shot.

11. Ducking a World Championship re-match:

Alekhine vs. Capablanca - Not definitively resolved. If pushed, I would tend to favor Capablanca given that pre-WW 2, there was no definitive cycle to choose the Challenger &, after all is said and done, it was the Champion who set the conditions & who chose his Challenger. AAA could & should have chosen Capa; & there was ample time, more than a decade, to do so before WW2. On the other hand, Capa's pride may have caused him to behave arrogantly & thus offend AAA. The issue is very much debatable. //

Kramnik vs. Kasparov - For me, it's resolved. Kudos to Kramnik for trying his best to install a decent Qualifying Event. Kasparov for his reasons clearly did not want to go through the Qualifying Event that he himself had pledged before losing his Title; & did not even seem serious in playing the solely FIDE champions. Why? I can only speculate that Kasparov would rather retire than risk a loss in a Qualifier or a match to either a FIDE champion or to Kramnik. If he regained his Title, he would be the greatest Champion in history, but there was risk involved. If he retired, he would still be the greatest Champion in history, but there would be no risk involved. Kasparov chose the latter & no one should blame him for that decision; & more so don't blame Kramnik!

12. Predictions for Hypothetical World Championship Matches:

Lasker vs. Pillsbury, Rubinstein, Maroczy - Lasker wins 2, loses 1 match //

Lasker vs. Capablanca (inexperienced) 1914 - Lasker close win //

Capablanca (not overconfident & not having TIAs) 1929 to 1937 vs. Alekhine or any other master - Capa win //

Alekhine (sober & prepared) vs. Capablanca (w/ severe HPN & numerous past strokes), Botvinnik, Keres, Fine, Reshevsky, Flohr 1939 - Alekhine win //

Alekhine (alcoholic, ill, & depressed) vs. Botvinnik 1946 - Botvinnik win //

Fischer (inactive for 3 years) vs. Karpov 1975 - Karpov win//

Kasparov vs. Shirov 2000 - Kasparov win. (But GKK should still have given it to Shirov. And don't blame Kramnik. Had Kramnik declined, GKK would have chosen another; & Shirov would still be frustrated.)


I have opened a <'multi-experimental' forum> below. Its nature is that of several secret social and psychological experiments, whose objectives and parameters, and the rules that follow, are strictly defined and which I may or may not reveal. Readers of this forum might be able to deduce some of these rules. Accordingly messages shall be retained or removed with or without explanation, even those from my dear friends here in CG, although I am making it clear here that absolutely no offense is intended to any one in this experiment. I may or may not respond to certain questions and messages, also according to the rules. To my friends: Please bear with me in this matter. There can be a certain amount of disinformation and propaganda in the messages that are retained.

The title of this <'multi-experimental' forum> is:

Biased Journal of a Fourth World Brain Operator

Some abbreviations

ASDH = Acute Subdural Hematoma, SDH incurred recently, usually less than a week

BT: Blood Transfusion

CAB = Continuous ambubagging

CiH = the public City Hospital

CNS = Central Nervous System

Craniectomy = neurosurgical procedure that involves removing a portion of the skull

CSDH = Chronic Subdural Hematoma, SDH that is more than two weeks old

CSF = Cerebrospinal Fluid

CVA = Cerebrovascular accident = stroke

EBRTL: Equally briskly reactive to light.

EDH = Epidural Hematoma, blood above the dura mater, the outer covering of the brain, and beneath the skull.

ETT = Endotracheal tube (for airway purposes)

EXTUBATION: the removal of a tube especially from the larynx after intubation—called also detubation.

FWB = Fresh Whole Blood

HCP = Hydrocephalus, too much CSF in the brain's ventricular system

INTUBATE: To put a tube in, commonly used to refer to the insertion of a breathing tube into the trachea for mechanical ventilation

MF = Motorcycle Fall

NGT = Nasogastric tube (for feeding purposes)

NOD = Nurse on duty

NRTL: Non reactive to light.

NSS: Normal Saline Solution

Oracle = personification of the CT (computed tomography) scan.

ProvH = the public Provincial Hospital

PrvH = Private Hospital. There are three main ones. So PrvH 1, PrvH 2, PrvH 3.

SDH = Subdural Hematoma, blood beneath the dura mater.

SOL = Space Occupying Lesion

SQ = Subcutaneous tissue layer of the skin or scalp

SRTL: Slowly or sluggishly reactive to light.

Tracheostomy = a surgical procedure to create an opening through the neck into the trachea (windpipe)

Uneventful day = Most likely still a busy day, making daily rounds in the hospitals, following up post-op patients, seeing patients in the OPD, answering referrals, admitting all kinds of patients in the hospitals; nevertheless a day in which nothing interesting has caught my attention.

Witching Hour Admissions or Referrals = 12 midnight to 5am.

>> Click here to see visayanbraindoctor's game collections. Full Member

   visayanbraindoctor has kibitzed 8951 times to chessgames   [more...]
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visayanbraindoctor: <twinlark> Pro-Russian mass media is against the US plan to send in troops to Syria. Not surprising. Yet some Syrians say that any US intervention is to take place only after Damascus approves. They imply that Tulsi Gabbard was actually sent to Syria with Trump's ...
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visayanbraindoctor: <perfidious> I'm not sure if you read my posts above correctly. If you have inadvertently misinterpreted them, let me point out that it is not a case in point because the extra classical tiebreak games (or game) are limited; not an indefinite format. As you ...
   Feb-13-17 visayanbraindoctor chessforum
visayanbraindoctor: 13 February 2017. 10M, hit by a van. The child was GCS 3, anisocoric, and also suffered from a right pulmonary contusion. CT scan showed a left thalamus hemorrhage which leaked into the third ventricle, causing hydrocephalus. I usually operate on such cases if they ...
   Jan-27-17 Carlsen vs B Adhiban, 2017 (replies)
visayanbraindoctor: Is this some kind of gambit? Adhiban offers a pawn. Carlsen as is his nature grabs the pawn. <Qa4+, Qxa7> In the process, White's Queen gets misplaced and Black gets a half open file and increased piece activity as adequate compensation. If Adhiban prepared this, he
   Jan-22-17 R Rapport vs Carlsen, 2017 (replies)
visayanbraindoctor: <ForkedAgain: So sad to be washed up at 26.> I don't think so. Carlsen is the best positional player in the world today, a head above everyone else. I have posted a speculation before, that he had reached his high plateau a couple of years ago. If he follows the ...
   Jan-13-17 Carlsen vs Karjakin, 2016
visayanbraindoctor: <Albion 1959> The Lasker vs Schlechter, 1910 game was highly tactical, with Schlecter coming out punching. He did not need to. <Bridegburner> and I made some notes to this game that you could peruse. I think its nature was quite different from this game. ...
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Kibitzer's Corner
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Premium Chessgames Member
  Jonathan Sarfati: So would you always check pupils as a diagnostic for brain injury? I guess an alternative would be needed for that blind patient in March 2015. Had to google GCS to find that means Glasgow Coma Scale.
Premium Chessgames Member
  visayanbraindoctor: <Jonathan Sarfati: So would you always check pupils as a diagnostic for brain injury?>

Yes. In case it's physically impossible to do that (because of eye or periorbital injury), I still note the sensorium (if low, it usually means increased intracranial pressure or diffuse axonal injury) and other localizing signs such as preferential movement of the right or left limbs (weakness on the right indicates injury on the left cerebral hemisphere and vice versa).

Premium Chessgames Member
  visayanbraindoctor: 2 December 2016.

52M, mauled.

In most of bihemisphere injuries, one side does not have significant contusions or hemorrhages, and so I operate only on the side where the injuries are creating dangerous mass effects. In 52M's case there were significant hemorrhages in both cerebral spheres, and so I decided to open up both sides of the skull.

(Right fronto - parietal and left frontal craniectomies, evacuation of acute subdural hmatoma, bone transplant to left hemi-abdomen SQ layer. 12/2/16 9:10 to 10:28 am. No BT.)

Premium Chessgames Member
  Travis Bickle: I hear you are very good at what you do. Dr. you've saved many dogs & cats lives!
Dec-10-16  falso contacto: Very interesting reading. Animals are great, specially when healthy. Disease make them quiet.
Premium Chessgames Member
  visayanbraindoctor: 17 December 2016.

51F, motorcycle fall, backrider, hit a tricycle.

Two days ago on admission, I thought she would make it without an operation, as by CT scan the acute subdural hematoma did not seem so large (about 30 cc). Then she exhibited a step down in her sensorium from GCS 9 to GCS 8, and developed right hemiparesis.

These borderline patients need to be monitored frequently. One never knows if and when they will deteriorate.

Pre-op BT was already done in order to compensate for the blood loss from a lacerated frontal scalp.

(Left temporo-fronto-parietal craniectomy, evacuation of acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 12/17/16 8:05 to 9:05 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 22 December 2016.

31M, shot by unknown assailant.

This patient's brain was oozing out of his right frontal skull bone. Strangely, I could not visualize the bullet in the CT scan. it seems to have gone through the ethmoid bone and oral cavity, and fractured his mandible.

The operation required me to flap the temporalis muscle and periosteum into the anterior fossa, in order to plug the hole made by the bullet in the ethmoid bone. (I also removed all the dead part of the frontal lobe so that it would not trigger swelling that could kill the patient.)

OR 1: (Right frontal craniectomy, evacuation of contused and infarcted brain and intracerebral hematoma, repair of dura for CSF leak with temporalis muscle flap, bone transplant to left hemi-abdomen SQ layer. 12/22/16 3:01 to 4:16 pm. No BT.)

OR 2: (Emergency tracheostomy. 12-22-16 4:25 to 4:38 pm.)

I also had to do a tracheostomy because his mandibular fracture was causing the tissues around his epiglottis to swell, which would eventually block his airway.

The patient recovered well, and was fully awake next day.

Then after more than a week, the NOD called me that he was suddenly bleeding profusely- through the tracheostomy, nose, mouth, anus. in less than an hour he had expired. I think he developed some kind of bleeding diathesis. (As is often the case in a public hospital, you think the patient is doing well, and suddenly the nurses call and he's dead.)

Premium Chessgames Member
  visayanbraindoctor: 23 December 2016.

Another repair opration. I don't know, but these happenings lead to the old adage that they come in pairs.

This time though, it was an old case I had operated on for an epidural hematoma secondary to a right frontal depressed fracture on 8-25-16.

22M developed rhinorrhea- CSF leak though the nose. It sems that the frontal fracture had also extended down to the ethmoid bone, creating a perforation on it. During his last admission, brain matter had probably plugged it, thus he did show signs of of a CSF leak; but this plug must have been reabsorbed.

OR 1: (Right frontal craniectomy, repair of dura for CSF leak with temporalis muscle flap, bone transplant to left hemi-abdomen SQ layer. 12/23/16 10:30 am to 12:39 pm. No BT.)

When I opened up. I found out that I could not visulize nor access the perforation extradurally. I figured it was located more posteriorly in the ethmoid, probably already near the anterior clinoid and the sella turcica (this is where the pituitary glans is located). So I did a cortisectomy and removed a small part of the frontal lobe. (The anteriormost portion of the frontal lobe is regarded as a 'silent' area.) I finally found the perforation by palpating the anterior fossa beneath the frontal lobe. I could actually poke my finger through it and into the ethmoid sinus.

I mobilized as much periosteum as I could and the right temporal muscle, and flapped it into the ethmoid perforation, thus closing it.

Post-op, 22M thankfully did not develop rhinorhea.

Premium Chessgames Member
  visayanbraindoctor: 24 December 2016.

78F, progressive decrease in sensorium one month PTA. AS in many cases of chronic subdural hematoma, it was an elderly patient with no clear history of trauma.

(Left fronto - parietal craniectomy, evacuation of chronic subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 12/24/16 7:04 to 7:50 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 25 December 2016.

28M, motorcycle fall, driver, hit another motorcycle.

(Left and right bi-frontal craniectomies, evacuation of acute subdural hematomas, bone transplant to left hemi-abdomen SQ layer. 12/25/16 6:50 to 8:00 pm. No BT.)

There was a dangerous sequelae to this case. The patient kept on scratching his incision sites, until the skin reopened on his left temple. CSF began to leak and the wound infected. Furthermore, CSF accummulatd beneath the scalp's galea, causing his forehead to swell. (I could see this when I did a repeat CT scan, which also ruled out a hydrocephalus.)

I readmitted the patient two weeks post-op. In my residency days, I thought you had to reopen these cases immediately, but my old master taught me that before such drastic action, one should try antibiotics and wrapping the head in tight elastic bandage first. Reopening the brain beneath an infected scalp might help spread the infection right into the brain.

In this case, the antibiotics (a third generation cephalosporin) plus elastic bandage management worked. After two more weeks, I discharged the patient, with a healed wound. The subgalea CSF collection had also been reabsorbed as could be seen in another CT scan done before discharge, and his forehead's swelling had disappeared.

Premium Chessgames Member
  visayanbraindoctor: 27 December 2016.

24M, shot by unknown assailant.

This patient also exhibited left hemiparesis, the side contralateral to the injury on his right brain. The bullet had entered the right frontal bone and exited the right parietal, skimming through the cortex.

OR 1: (Right fronto - parietal craniectomy, evacuation of contused and infarcted brain and hematomas, repair of dura for CSF leak with temporalis muscle flap, bone transplant to left hemi-abdomen SQ layer. 12/27/16 8:57 to 10:40 pm. No BT.)

Thankfully this one did not develop complications. His paresis even improved before discharge.

Premium Chessgames Member
  visayanbraindoctor: 25 December 2016.

20M, motorcycle fall, driver, hit a truck.

The patient was already GCS 3, with bilaterally dilated pupils upon arrival. The parents insisted that I operate, since the truck's company would pay anyway, and they wanted everything that could be done to be done for their son.

In these cases, afer I tell them of the bad prognosis, I oblige the family, or I might get blamed for the death of their loved one. (Our son died because his doctor did not operate!)

I operated fast and did not bury the bone for future replacement.

Right fronto- paietal craniectomy, evacuation of acute subdural hematoma. 12/31/16 8:34 to 8:50 am. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 31 December 2016 to 1 January 2017.

The new President (Duterte) had banned firecrackers. So instead of popping firecrackers, the people took to hooting horns as loud as thay can.

I am for the ban. Too many fingers get amputated. Vehicular accidents occur secondary to startled drivers.

Premium Chessgames Member
  visayanbraindoctor: 9 January 2017.

Most gunshot cases I receive that are still alive in the ER consists of single shots fired into the head. 52M was unusual because he had one to the head (through the right mastoid), and one in the right chest.

He died in the ER.

I wondered if whoever did this employed the double tap method of professional assassins- one shot to the head and another to the chest.

Premium Chessgames Member
  visayanbraindoctor: 12 January 2017.

An unusual case. 57M was admitted more than two weeks ago in the public CiH after he got mauled. The CT scan then showed a left frontal lobe contusion and linear frontal bone fracture. No need to operate.

The patient remained stuporous and then began to deteriorate after two weeks. A repeat CT scan showed infarcts on both frontal lobes.

OR 1: Bifrontal craniectomies, partial bi frontal lobectomies, bone transplant to left hemiabdomen SQ layer. 1-12-17 10:25 am to 12:07 pm. No BT.

OR 2: Tracheostomy. 1-12-17 12:24 to 12:39 pm.

Since he had also developed pneumonia and had embarked on the sepsis roller coaster ride, I wasn't optimistic about his survival. Yet survive he did. I removed his tracheostomy two weeks post-op. I discharged him nearly three weeks post-op.

Premium Chessgames Member
  visayanbraindoctor: 18 January 2017.

16M, motorcycle fall, driver, hit another motorcycle.

He had a huge 70 cc epidural hematoma, but was still GCS 14 preo-op. I removed the hematoma. When these EDH cases deteriorate, they do so fast.

OR: Right parieto- temporal craniectomy, evacuation of epidural hematoma, bone transplant to left hemiabdomen SQ layer. 1-18-17 10:28 to 11:16 am. No BT.

Premium Chessgames Member
  visayanbraindoctor: 19 January 2017.

44M, whom I previously operated on 9-27-16 for subacute subdural hematoma.

OR: Replacement of bone flap right fronto- parietal. 1-19-17; 9:23 to 10:34 am. No BT.

Premium Chessgames Member
  visayanbraindoctor: 27 January 2017.

14M, whom I previously operated May 2016 for epidural hematoma.

OR: Replacement of bone flap left temporo- parietal. 1-27-17; 4:19 to 5:14 pm. No BT.

Premium Chessgames Member
  visayanbraindoctor: 4 February 2017.

49M, motorcycle fall, driver, hit a dog.

OR: Right fronto- parietal craniectomy, evacuation of acute subdural hematoma, bone transplant to left hemiabdomen SQ layer. 2-4-17; 4:04 to 4:50 pm. No BT.

A nightmare case.

Four hours post-op, the the CiH nurse texted me that the patient was having BP spikes of 180 systolic. I thought it was because of pain, and I duly ordered IV Tramadol RTC. Past midnight nine hours post-op, the NOD again texted me that the patient had suddenly gone on CP arrest. He died after 30 minuts of CPR. I wasn't able to sleep well at all.

I think he was developing a massive infarct while I was operating, as I noticed his brain was not pulsating during the opertion itself.

Premium Chessgames Member
  visayanbraindoctor: 8 February 2017.

16M, whom I previously operated on June 2016 for epidural hematoma.

OR: Replacement of bone flap right temporo- parietal. 2-8-17; 9:40 to 10:30 am. No BT.

Premium Chessgames Member
  visayanbraindoctor: 9 February 2017.

63M, sudden decrease in sensorium and right hemiparesis, with history of HPN, CT scan showing a large 60 left basal ganglia hemorrhage.

It was dawn, and my cell phone's ringing woke me up. I was informed that the patient arrived in Prh1 GCS 11, and then deteriorated to GCS 3. So I grabbed my scrub suit, placed it in my duffle bag, dressed up, put on a jacket and boots. It was pouring a torrent of rain outside and the street below me was flooded. Fortunately there were still PUVs running.

The patient's pupils were 2mm EBRTL. The wife had decided strongly on an operation. Given he had just deteriorated and his pupils reactive, I operated on him stat, with no blood in reserve. (Fortunately I seldom have bleeding problems during my operations. I operate clean and fast, which is great in emergency situations when there is no time to get blood.)

OR: Left fronto- parieto- temporal craniectomy, cortisectomy, evacuation of basal ganglia hemorrhage, hemostasis, bone transplant to left hemiabdomen SQ layer. 2-9-17 8:56 to 10:10 am. No BT.

This hemorrhage was deeply located. I decided to approach it via a large frontal cortisectomy, trying to avoid the motor cortex on the pre-sulci gyrus which unfortuately was not entirely possible due to the location of the hemorrhage beneath it.

Not sure if the patient will survive. He had low sensorium pre-op, an indicator for bad prognosis.

Premium Chessgames Member
  visayanbraindoctor: 10 February 2017.

I woke up and had to get out of my apartment building near midnight building because of an earthquake. My old computer slid off its table and hit the floor hard.

Premium Chessgames Member
  visayanbraindoctor: 12 February 2017.

42M, motorcycle fall, driver, alone.

OR: Right fronto- parieto- temporal craniectomy, evacuation of acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 2/12/17 12:01 to 1:00 pm. No BT.

Awake post-op.

Premium Chessgames Member
  visayanbraindoctor: 12 February 2017.

26M, motorcycle fall, backrider.

Left temporo- parietal craniectomy, evacuation of acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 2/12/17 9:20 to 10:11 pm. No BT.

During the earthquake on February 10 (see above), the road cracked in front of the motorcycle the patient was riding on. The surface right in front of them slanted up. Thus the motorcycle flew up off the road and crashed.

Premium Chessgames Member
  visayanbraindoctor: 13 February 2017.

10M, hit by a van.

The child was GCS 3, anisocoric, and also suffered from a right pulmonary contusion. CT scan showed a left thalamus hemorrhage which leaked into the third ventricle, causing hydrocephalus.

I usually operate on such cases if they happen to be children, as they sometimes recover. Instead of the usual Burr hole, I decided to do a craniectomy on the side of the lesion in order to provide more space for the herniating brain.

Left frontal craniectomy, tube ventriculostomy, evacuation of acute intra-ventricular hemorrhage and CSF. 2/13/17 6:00 to 6:30 pm. No BT.

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