Clinical research progress on pediatric lung transplantation / 器官移植

Lung transplantation is an efficacious treatment for end-stage lung diseases in children. Shortage of donor lungs, poor donor-recipient matching, difficult postoperative management, multiple postoperative complications and high fatality jointly restrict the development of pediatric lung transplantation. However, significant progress has been achieved in each transplantation center along with the popularization of organ donation after citizen' s death, advancement of medical science and technology and accumulation of lung transplantation experience. In recent years, clinical application of donor lung from donation after brain death and marginal donor lung repair, maturity of perioperative life support technology and surgical transplantation procedure and reference of management experience after adult lung transplantation have accelerated rapid development of pediatric lung transplantation. In this article, current status and progress on primary diseases, utilization and allocation of donor lungs, selection of surgical techniques, management of postoperative complications and clinical prognosis of pediatric lung transplantation were elucidated, aiming to provide reference for clinical diagnosis and treatment.

Sushruta on human dissection as pre-requisite to surgery / Sushruta sobre la disección humana como requisito previo a la cirugía

SUMMARY: In the western surgical tradition there has been little acknowledgement of the ancient Vedic surgeon Sushruta who initiated many aspects of surgical practice. In his compendium the Sushruta Samhita, Sushruta systematised medicine in various areas. His meticulous knowledge in many branches of medicine is evident. A brilliant surgeon, he developed plastic surgical techniques, types of bandaging, hygiene practices and over one hundred surgical instruments. In this article, I focus on Sushruta's ideas on human dissection as a pre-requisite for surgery, his method of preparation of human cadavers and his anatomical pedagogy. Sushruta pioneered the instruction of cadaveric based anatomical learning which is still being used in medical teaching.

RESUMEN: En la tradición quirúrgica occidental existe escaso reconocimiento del antiguo cirujano védico Sushruta, quien inició muchos aspectos de la práctica quirúrgica. En su compen-dio, el Sushruta Samhita, Sushruta sistematizó la medicina en varias áreas. Es evidente su meticuloso conocimiento en muchas ramas de la medicina. Cirujano brillante, desarrolló técnicas de cirugía plástica, tipos de vendajes, prácticas de higiene y más de cien instrumentos quirúrgicos. El enfoque de este artículo se centra en las ideas de Sushruta sobre la disección humana como requisito previo para la cirugía, su método de preparación de cadáveres humanos y su pedagogía anatómica. Sushruta fue pionero en la instrucción del aprendizaje anatómico basado en cadáveres que todavía se utiliza en la enseñanza médica.

Progresses in clinical treatment of multiple rib fractures and flail chest / 中国胸心血管外科临床杂志

@#The incidence of rib fracture in patients with chest trauma is about 70%. Simple rib fractures do not need special treatment. Multiple rib fractures and flail chest are critical cases of blunt trauma, which often cause serious clinical consequences and need to be treated cautiously. Nowadays, there is a controversy about the diagnosis and treatment of multiple rib fractures and flail chest. In the past, most of the patients were treated by non-operative treatment, and only less than 1% of the patients with flail chest underwent surgery. In recent years, studies have confirmed that surgical reduction and internal fixation can shorten the hospital stay, and reduce pain and cost for patients with flail chest, but there is still a lack of relevant clinical consensus and guidelines for diagnosis and treatment, which leads to great differences in clinical diagnosis and treatment plans. This article reviewed the treatment, surgical indications and surgical timing of multiple rib fractures and flail chest.

Research progress in the selection of surgical methods and complications of orbital decompression in the treatment of Graves ophthalmopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#Graves ophthalmopathy(GO)is the most common and relatively complicated orbital diseases, and the incidence rate is increasing year by year. Severe GO may present with exposure keratopathy, diplopia and compressive optic neuropathy, which seriously affects influences patients quality of life. At present, orbital decompression is an effective method in the treatment of moderate and severe GO, and with the continuous expansion of indications for orbital decompression, more and more patients with mild and moderate GO with exophthalmos require surgical treatment to improve the appearance. There are many different surgical techniques for orbital decompression, and which one can achieve patients' maximum benefit is a frequently encountered clinical problem for ophthalmologist. With the gradual increase of the amount of surgery, complications become increasingly prominent, which affect postoperative satisfaction of patients. In order to deepen the understanding of complications, avoid or reduce the occurrence of complications, and optimize the operation plan, this paper reviews the relevant literature at home and abroad in recent years, and summarizes the selection of operation methods and operation related complications of orbital decompression in GO patients.

Modified surgical method for supra- and infratentorial epidural hematoma and related anatomical study of the squamosal part of the occipital bone / 西安交通大学学报(医学版)

Objective: To explore the modified surgical method of supra- and infratentorial epidural hematoma (SIEDH) and analyze the related anatomy of the occipital bone. Methods: CT scan data of 30 adult patients with no history of craniocerebral trauma were collected in our hospital from January to August 2019. The median sagittal plane was taken to define line A (from lambdoid suture to the extraoccipital turbercle) and line B (from extraoccipital turbercle to the posterior edge of the foramen magmun). The angle θ was defined between the two lines. The mean value of θ was analyzed for comparison between genders and for exploration of the anatomical basis of single supratentorial craniotomy for SIEDH. Eight patients with SIEDH were recruited in the same period to analyze the procedure and results of the modified surgical method. Results: The average angle of the θ was (117.4±4.3)° for men and (130.0 ±4.9)° for women; the minimum was 108.3° for men and the maximum was 138.7 ° for women. The θ was smaller in men than in women (P<0.001). The smaller the angle was, the more conductive it was to detect the lesions from superior to inferior tentorial apartment. The bone flaps of the eight patients were designed above the transverse sinus. During the operation, epidural hematoma was completely removed, and no skull defects occurred like in conventional supra-inferior tentorial craniotomy. Conclusion: The supratentorial craniotomy above the tranverse sinus has reliable anatomical basis and is an effective surgical method for SIEDH.

Comparison of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in treatment of complete concealed penis / 中国修复重建外科杂志

Objective: To evaluate the effectiveness of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in the treatment of complete concealed penis. Methods: The clinical data of 46 children with complete concealed penis between January 2016 and January 2018 were analyzed retrospectively. Among which, 25 cases were treated with pedicled skin flap of foreskin for phalloplasty (group A) and 21 cases were treated with Sugita surgical method (group B) with an average age of 4.7 years (range, 2 years and 8 months to 11 years). At 3 months after operation, the concealed penis recovery was scored from three aspects of postoperative penis length (the difference of the penis length between at 3 months after operation and before operation), penis appearance, and skin appearance (the total score was 10). And the parents evaluation of satisfaction degree of penis exposure, penis appearance, and foreskin appearance after surgical correction was collected. Results: Eighteen cases (72.0%) in group A and 15 cases (71.4%) in group B were followed up with an average of 13 months (range, 3-36 months). The incisions healed well in both groups, and there was no flap dehiscence, infection, necrosis, and penile erectile dysfunction. The penile length of the two groups increased significantly at 3 months after operation ( P0.05). No penile retraction occurred in the two groups. And there was no significant difference between the two groups in penis appearance score, but the penis appearance score, skin appearance score, and total score of group A were significantly better than those of group B ( P<0.05). At 3 months after operation, the satisfaction rate of penis exposure in group A and group B was 88.9% and 80.0%, respectively, with no significant difference ( χ2=0.50, P=0.48); the satisfaction rate of penis appearance was 72.2% and 53.3%, and the satisfaction rate of foreskin appearance was 94.4% and 53.3%, respectively, and the differences were significant ( χ2=5.13, P=0.03; χ2=7.53, P=0.01). Conclusion: Both surgical methods are suitable for correction of complete concealed penis, and the penile length gets a satisfactory recovery. However, the lymphedema of the prepuce after Sugita surgical method is serious, which can easily lead to poor appearance of the penis after operation. In general, the effectiveness of pedicled skin flap of foreskin for phalloplasty is better than that of the Sugita surgical method.

Clinical research of laparoscopic common bile duct exploration with primary suture and T tube drainage in the management of choledocholithiasis / 国际外科学杂志

Objective@#To investigate the short-term clinical efficacy of laparoscopic common bile duct exploration(LCBDE) with primary suture or T tube drainage in the management of choledocholithiasis.@*Methods@#The retrospective cohort study was conducted from January 2014 to December 2018 with the clinical data of patients with choledocholithiasis being analyzed. A total of 863 patients were enrolled in this study. There were 431 males and 432 females. The median age was 60 (range 11 to 94). These patients had received LCBDE with primary suture (n=287) and T tube drainage (n=576) in the Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University. Observation indicators: (1)Preoperative blood biochemistry, including blood serum levels of total bilirubin, direct bilirubin, ALT, AST, GGT. (2) Intraoperative conditions, including operation time, blood loss, diameter of common bile duct, number of common bile duct stone.(3)Short-term postoperative conditions, including postoperative hospital stay, postoperative complications. Measurement data with non-normal distribution were described as M (P25, P75), and comparison between groups was done using Mann-Whitney U test. Comparison of count data between groups were analyzed using the chi-square test. Univariate analysis and subsequent multivariable logistic regression were used to investigated the factors affecting the selection of surgical methods.@*Results@#(1) Blood serum levels of total bilirubin and direct bilirubin in the T tube drainage group were 17.0(12.2, 36.0) μmol/L, 7.6(4.9, 19.0) μmol/L, which were significantly higher than those of the primary suture group[15.7(11.8, 29.7) μmol/L, 6.7(4.4, 16.5) μmol/L)](Z=-2.023, -2.468, P<0.05). Preoperative blood serum levels of ALT, AST and GGT in the T tube drainage group were 56.7 (26.6, 128.8) U/L, 38.0(24.3, 75.8) U/L and 179.7(50.8, 394.4) U/L, the primary suture group were[68.2(24.8, 165.3) U/L, 35.5(22.8, 96.9) U/L and 235.2(74.9, 459.1) U/L], with no difference between the two groups (Z=-0.985, -0.437, -1.740, P>0.05). (2)The operation time of the primary suture group was 85(70, 100) min, which was significantly shorter than that of the T tube drainage group[97(75, 120) min](Z=-5.532, P<0.05). The diameter of common bile duct in the primary suture and T tube drainage group were 1.0(0.8, 1.2) cm and 1.0(0.8, 1.2) cm, respectively. Significant difference was observed between the two groups(Z=-2.071, P<0.05). The intraoperative blood loss in the primary suture and T tube drainage group were 20(10, 50) ml and 20(20, 50) ml, with no difference between the two groups (Z=-0.477, P>0.05). 61.32%(176/287) and 67.36%(388/576) of patients in the primary suture group and T tube drainage group were found with multiple stones in the common bile duct, with no difference between the two groups (χ2=3.083, P>0.05). (3)The primary suture group showed shorter postoperative hospital stay compared with the T tube drainage group[4(3, 5) d vs 6(5, 6) d, Z=-12.057, P<0.05]. The primary suture group showed more patients with bile leakage (2.09%) compared with that of the T tube drainage group (0.35%). Multivariable logistic regression showed that the number of common bile duct stone, diameter of common bile duct, time period of surgery, surgery group were significant factors affecting the selection of surgical methods(OR=1.687, 2.423, 0.587, 4.632, 95%CI: 1.152-2.470, 1.519-3.865, 0.511-0.675, 3.698-5.802, P<0.05).@*Conclusions@#Although different surgeons showed different opinions with the method of primary suture, laparoscopic common duct exploration with primary suture is safe and reliable in the management of choledocholithiasis with shorter operation time and faster postoperative recovery. T tube drainage is not absolutely necessary in the management of choledocholithiasis. Patients with multiple common bile duct stone or large diameter of common bile duct are likely to receive T tube drainage.

Clinical research of laparoscopic common bile duct exploration with primary suture and T tube drainage in the management of choledocholithiasis / 国际外科学杂志

Objective To investigate the short-term clinical efficacy of laparoscopic common bile duct exploration(LCBDE) with primary suture or T tube drainage in the management of choledocholithiasis.Methods The retrospective cohort study was conducted from January 2014 to December 2018 with the clinical data of patients with choledocholithiasis being analyzed.A total of 863 patients were enrolled in this study.There were 431 males and 432 females.The median age was 60 (range 11 to 94).These patients had received LCBDE with primary suture (n =287) and T tube drainage (n =576) in the Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University.Observation indicators:(1) Preoperative blood biochemistry,including blood serum levels of total bilirubin,direct bilirubin,ALT,AST,GGT.(2) Intraoperative conditions,including operation time,blood loss,diameter of common bile duct,number of common bile duct stone.(3) Short-term postoperativeconditions,including postoperative hospital stay,postoperative complications.Measurement data with non-normal distribution were described as M (P25,P75),and comparison between groups was done using Mann-Whitney U test.Comparison of count data between groups were analyzed using the chi-square test.Univariate analysis and subsequent multivariable logistic regression were used to investigated the factors affecting the selection of surgical methods.Results (1) Blood serum levels of total bilirubin and direct bilirubin in the T tube drainage group were 17.0(12.2,36.0) μmol/L,7.6 (4.9,19.0) μmol/L,which were significantly higher than those of the primary suture group[15.7 (11.8,29.7) μmol/L,6.7 (4.4,16.5) μmol/L)] (Z =-2.023,-2.468,P ＜ 0.05).Preoperative blood serum levels of ALT,AST and GGT in the T tube drainage group were 56.7 (26.6,128.8) U/L,38.0 (24.3,75.8) U/L and 179.7 (50.8,394.4) U/L,the primary suture group were [68.2 (24.8,165.3) U/L,35.5(22.8,96.9) U/L and 235.2(74.9,459.1) U/L],with no difference between the two groups (Z =-0.985,-0.437,-1.740,P ＞ 0.05).(2) The operation time of the primary suture group was 85 (70,100) min,which was significantly shorter than that of the T tube drainage group [97 (75,120) min] (Z =-5.532,P ＜ 0.05).The diameter of common bile duct in the primary suture and T tube drainage group were 1.0(0.8,1.2) cm and 1.0 (0.8,1.2) cm,respectively.Significant difference was observed between the two groups(Z =-2.071,P ＜ 0.05).The intraoperative blood loss in the primary suture and T tube drainage group were 20(10,50) ml and 20(20,50) ml,with no difference between the two groups (Z =-0.477,P ＞0.05).61.32％ (176/287) and 67.36％ (388/576) of patients in the primary suture group and T tube drainage group were found with multiple stones in the common bile duct,with no difference between the two groups (x2 =3.083,P ＞ 0.05).(3)The primary suture group showed shorter postoperative hospital stay compared with the T tube drainage group [4 (3,5) d vs 6 (5,6) d,Z =-12.057,P ＜ 0.05].The primary suture group showed more patients with bile leakage (2.09％) compared with that of the T tube drainage group (0.35％).Multivariable logistic regression showed that the number of common bile duct stone,diameter of common bile duct,time period of surgery,surgery group were significant factors affecting the selection of surgical methods (OR =1.687,2.423,0.587,4.632,95％CI:1.152-2.470,1.519-3.865,0.511-0.675,3.698-5.802,P＜0.05).Conclusions Although different surgeons showed different opinions with the method of primary suture,laparoscopic common duct exploration with primary suture is safe and reliable in the management of choledocholithiasis with shorter operation time and faster postoperative recovery.T tube drainage is not absolutely necessary in the management of choledocholithiasis.Patients with multiple common bile duct stone or large diameter of common bile duct are likely to receive T tube drainage.

Comparison and discussion of different surgical methods used to treat vesicovaginal fistulas / 北京大学学报(医学版)

Objective:To compare the feasibility and prognosis of different surgical methods used for vesicovaginal fistulas and to explore the value of electrocoagulation treating small ones.Methods:The medical data of 19 patients who had undertaken transvaginal VVF repairs in Peking University People's Hospital between October 2008 and November 2016 were retrospectively collected.The follow-ups were performed.The patients' age ranged from 31 to 55 years with the median age of 48 years and the history length ranged from 1 month to 24 months with the median length of 3 months.Their fistula situation,surgical methods and prognosis were analyzed and the differences and similarities were compared.Results:Three patients (15.79％) was performed by electrocoagulation,4 (21.05％) by transvaginal repair,5 (21.32％) by laparoscopic repair and 7(36.84％) by open operation.Except one patient who rejected urinary catheter and D-J catheters,the rest of the patients discharged with catheters.Twelve patients (63.2％) got full satisfaction with one operation.One of the 3 patients who undertook electrocoagulation repeated the operation for twice and got completely cured within 1 month while the other two undertook the operation once and got dry within 1 month.Three patients who undertook transvaginal repair got dry within 1 month.Two of the 5 patients who undertook laparoscopic repair had readmission for a second operation and the other 3 got dry after operation.Five of the 7 open repair patients got dry while the other 2 attempted other center for treatment.Conclusion:Transvaginal repair has been the main surgery procedure for VVF,but it is limited by the location of fistula and the condition of vaginal.For patients not suitable for transvaginal repair,laparoscopic repair and open surgery are feasible.However both laparoscopic repair and open surgery are more invasive.Based on that,electrocoagnlation becomes a better choice.In our research,patients with small and high location fistula treated by electrocoagulation got a higher cure rate and bear less surgical trauma.Electrocoagulation used in the treatment of VVF showed advantages of less trauma,less bleeding and better satisfaction.Fistulas with low location were more suitable for transvaginal repair.Complex VVF,especially with narrow ureteral open and ureteral fistulas,were more suitable for open and laparoscopic repair.As for single and small fistula,the electrocoagulation can be the first choice.

Surgical method and extent of reoperation in patients with concomitant strabismus / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the surgical method and extent of reoperation in the concomitant strabismus patients with surgical under-correction and over-correction. METHODS: Ninety - six concomitant strabismus patients with surgical under - correction and over -correction were recruited in this study, which included 41 males and 55 females, aged 21. 90±14. 70. All individuals underwent routine eye examinations for strabismus before the surgery. Among the cases with concomitant esotropia, there were over-correction in 23 cases, under-correction in 15 cases. Among the cases with concomitant exotropia, there were over-correction in 28 cases, under - correction in 30 cases. The method of reoperation were based on angle of deviation, the method of original operation and acute visual acuity of patients. RESULTS:In over - correction cases with concomitant esotropia, medial rectus muscle of 9 cases were advanced, the corrective extent was (5. 51±2. 63) ? / mm;9 cases were performed advance of medial rectus muscle and recession of lateral rectus muscle, the corrective extent was (6. 25±1. 59) ? / mm; 3 cases were performed resection of medial rectus muscle and recession of lateral rectus muscle, the corrective extent was (4. 26±1. 04) ? /mm; only 2 cases were performed recession of lateral rectus muscle, the corrective extent was (4. 21±1. 91) ? /mm. In under - correction cases with concomitant esotropia, 6 cases were performed resection of lateral rectus muscle, the corrective extent was (4. 03±0. 98) ? /mm; 6 cases were performed resection of lateral rectus muscle and recession of medial rectus muscle, the corrective extent was (6. 86 ± 1. 32) ? / mm; 3 cases were performed recession of medial rectus muscle, the corrective extent was ( 4. 33 ± 0. 29 ) ? / mm. In over -correction cases with concomitant exotropia, 16 cases were performed advance of lateral rectus muscle, the corrective extent was (5. 37 ± 1. 56) ? / mm; 6 cases were performed recession of medial rectus muscle, the corrective extent was (6. 29 ± 3. 68) ? / mm; 5 cases were performed advance of lateral rectus muscle and recession of medial rectus muscle, the corrective extent was (5. 46±1. 78) ? / mm; 1 case were performed resection of lateral rectus muscle, the corrective extent was 5. 00? / mm. In under - correction cases with concomitant exotropia, 12 cases were performed resection of medial rectus muscle, the corrective extent was (4. 47 ± 0. 54) ? / mm; 16 cases were performed recession of lateral rectus muscle and resection of medial rectus muscle, the corrective extent was ( 5. 11 ± 0. 75 ) ? / mm; 2 cases were performed recession of lateral rectus muscle, the corrective extent was (2. 65±0. 42) ? / mm. CONCLUSION: In reoperation of concomitant strabismus patients with over-correction, weakening or/and strengthening the horizontal muscle which were performed surgery before has a greater and more unstable surgical corrective extent. While In reoperation of concomitant strabismuspatients with under -correction, weakening or/ and strengthening the horizontal muscle which were not performed surgery has a normal corrective extent as usual.

The impact of different surgical method and different doses of euthyrox on bone mineral density / 中国基层医药

Objective To investigate the impact of different surgical methods and different doses of euthyrox on bone mineral density.Methods A sample of 40 patients received thyroid cancer operation (excised affected side leaf,aisthmus,most of offside and neck VI lymph node dissection)and 40 patients received nodular goiter operation (excised affected side leaf)were collected,the dose of euthyrox taken in was 85 .2μg in thyroid cancer patients and 36.2μg in nodular goiter patients daily,the bone mineral density 6 month and 1 year after operation was detected. Results There was no difference of BMD between the two group 6 month after operation (P>0.05),but BMD of the observation group was (0.64 ±0.28)g/m2,which was lower than that of control group (t=2.235,P=0.03).Com-pared with pre-operation,BMD of control group had no change and the observation group appeared drop 1 year after operation.Conclusion Patients received thyroid cancer taking in euthyrox may show BMD reduced,especial 1 year after operation,doctors should be on the alert and supplement calcium appropriately.

Femoral lengthening / 中华创伤骨科杂志

Limb lengthening has been applied to deal with inequality of lower limb for a long time. In some special cases femoral lengthening can be chosen for the treatment, though this technique is more difficult than tibial lengthening. We have reviewed in this paper the indications, different methods, newest devices and skills, prevention and cure of complications in femoral lengthening. Because of the high incidence of complications due to this operation, doctors should be very cautious when they determine the cases for the operation.

The Study of Applying Method and Time for Improving Treatment Result in Cryosurgery: Theory of Selective Cryolysis / 대한피부과학회지

BACKGROUND: Cryosurgery uses freezing temperatures to achieve specific effects on tissues, and this method has been used to treat various skin diseases for the last five decades. The modern cryosurgery is especially effective on the treatment of benign, premalignant and malignant lesions including keloid, hypertrophic scar and pigmented disease such as Ota nevus. The results of cryosurgery depend on such factors as types of cryogen, freezing and thawing time, and numbers of the freezing-thawing cycle. OBJECTIVE: The purpose of this study is to show differences among groups of disease, sites of treatment and applying methods through comparing freezing and thawing time. And specifying the optimum applying methods for the treatment of each specific disease is studied. METHOD: To attain the goal of the study, operation records of 224 patients, who received cryosurgical treatment at the Ewha Woman's University Dongdaemoon Hospital, have been analyzed. RESULTS: 1. The numbers of male and female patients of selected group were 74 and 150, respectively, and their ages between 2 and 54 years. Among the group, 42 patients had epidermal pigmentary disease, 77 had dermal pigmentary disease and 105 had scars. 2. Ratios of TT(thawing time) to FT(freezing time) were significantly different among groups of disease(p<0.05). 3. Ratios of TT to FT were significantly different among groups of treatment site(p<0.05). 4. Ratios of TT to FT showed great difference between the group of rolling method applied and one of pressure method applied(p<0.05). CONCLUSION: The output of this study indicates that the result of the cryosurgery tends to be heavily influenced by the surgical method that is employed. It also proves that the pressure method tends to inflict more severe cryoinjury on the tissues than the rolling method. Each different tissue shows different sensitivity to the cold injury, and the longer the thawing time is, the more cryoinjury of tissues occurs. Therefore, to achieve the maximum therapeutic result while minimizing the undesired effect, adequate surgical method should be selected and applied to each specific disease. This concept is introduced in this study as "Theory of Selective Cryolysis.".

Aneurysms of the Posterior Inferior Cerebellar Artery

Aneurysms of the posterior inferior cerebellar artery are uncommon, comprising between 0.5 and 0.7% of all intracranial aneurysms and are usually tightly confined to the medulla oblongata, the anterolateral base of the skull, and the lower cranial nerves. During the period from January 1983 to December 1997, about 1,600 aneurysms were operated on the department of neurosurgery, Pusan Paik hospital, Inje University. Of these, there were 8 cases of aneurysms in the posterior inferior cerebellar artery(PICA). The average age was 43.2 years, with a range from 11 months to 56 years, and male to female ratio was equal. Presenting signs and symptoms on admission were mental deterioration and/or headache after subarachnoid hemorrhage in 7 cases and suboccipital headache due to mass effect in 1 case. The locations of these aneurysms were in the anterior-medullary segment in 4 cases, in the lateral medullary segment in one case, and telovelotonsillar segment in 3 cases. Surgical methods were as followed; unilateral suboccipital craniectomy or craniotomy(right side in 3 cases and left side in 2 cases) in lateral or park bench position was performed in 5 cases and suboccipital craniectomy in prone position was in 3 cases. Direct neck clipping were done in 5 cases, proximal ligation in 1 case, coating and trapping in 1 case each. Surgical results were good in 5 cases, fair in 2 cases, dead in a case. Although clipping of the aneurysm neck was preferable in the aneurysm of PICA, trapping was useful when neck clipping was impossible in segments distal to the choroidal arch.