Abstract：
This is a post hoc multivariate analysis of the modified World Federation of Neurosurgical Societies (WFNS) grading project, multicenter prospective observational study including 38 neurosurgical institutions across Japan. Japan Neurosurgical Society WFNS grading committee conducted a modified WFNS grading project as a nationwide prospective registry study. We investigate the clinical outcome of both surgical and endovascular interventions after aneurysmal subarachnoid hemorrhage (SAH) in Japan. A total of 792 patients received surgical intervention and 417 patients received endovascular treatment. Eight hundred patients were female, and 409 patients were male. The mean age was 61.5 ± 13.7 years. At 3 month follow-up, there was no statistically significant difference in good clinical outcome between surgical (68.2%) and endovascular (60.9%) group (odds ratio, 0.89; 95% confidence interval, 0.68-1.16; p = 0.381). Unfavorable outcome rate was 31.8% (238 patients) in the surgical group and 39.1% (154 patients) in the endovascular group. Male, elderly people, modified Rankin scale condition before onset, high-grade modified WFNS clinical grading scale, intracerebral hematoma, posttreatment normal pressure hydrocephalus, and neurological deficit due to symptomatic vasospasm were risk factors for the clinical outcome. Treatment modality was not a statistical factor for clinical outcomes. Surgical clipping has still a major role in the management of SAH in Japan. The present study was not a randomized controlled study, but clinical outcome is not influenced by treatment modalities.
摘要：
这是对经过修改的世界神经外科学会联合会（WFNS）分级项目的事后多变量分析，包括日本38个神经外科机构的多中心前瞻性观察研究。日本神经外科学会WFNS分级委员会进行了一项改良的WFNS分级项目，作为一项全国性的前瞻性注册研究。我们调查了日本动脉瘤性蛛网膜下腔出血（SAH）后手术和血管内介入治疗的临床结果。共有792例患者接受了手术干预，417例患者接受了血管内治疗。八百名患者是女性，409例患者为男性。平均年龄为61.5±13.7岁。在3个月的随访中，手术组(68.2%)和腔内治疗组(60.9%)的良好临床疗效差异无统计学意义(比值比,0.89；95%置信区间，0.68-1.16；p=0.381）。手术组的不良转归率为31.8％（238例），血管内组的不良转归率为39.1％（154例）。男性,老年人,发病前改良Rankin量表状态，高级改良WFNS临床分级量表，脑内血肿，治疗后正常压力性脑积水，症状性血管痉挛引起的神经功能缺损是临床结局的危险因素。治疗方式不是临床结果的统计学因素。在日本，手术夹闭在SAH的管理中仍然具有主要作用。本研究不是随机对照研究，但临床结局不受治疗方式的影响.
