Effectiveness of Goreisan Herbal Medicine in Preventing Recurrence After Chronic Subdural Hematoma Surgery: A Systematic Review and Meta-Analysis

Abstract

Introduction: Chronic subdural hematoma (CSDH) is a common condition among older adults that frequently necessitates surgical intervention. Despite advancements in surgical techniques, recurrence remains a significant concern. Goreisan, a traditional herbal medicine, has been proposed as a potential treatment to reduce the recurrence rate of CSDH. Methods: On August 1, 2024, a systematic search was conducted using PubMed, Web of Science, Cochrane Library, Wanfang Data, and Ichushi databases to identify studies evaluating the effect of Goreisan on CSDH recurrence. Data from randomized controlled trials (RCTs) and retrospective studies were extracted and pooled using a random-effects model. Results: A total of ten studies involving 8,073 patients were analyzed, with 4,699 patients receiving treatment with Goreisan. The pooled analysis of RCTs showed an odds ratios (OR) of 0.55 (95% confidence interval [CI]: 0.30 to 1.02, p = 0.06; I² = 20%), suggesting a trend toward reducing recurrence. Retrospective studies revealed an OR of 0.67 (95% CI: 0.44 to 1.01, p = 0.05; I² = 46%). The overall analysis of all included studies for CSDH recurrence reduction showed an OR of 0.64 (95% CI: 0.46 to 0.88, p = 0.006; I² = 35%), indicating a statistically significant reduction in recurrence. A meta-analysis of three studies reporting adverse events yielded an OR of 4.95 (95% CI: 0.56 to 43.97, p = 0.15; I² = 0%), with no significant increase in adverse events. Conclusion: Goreisan appears to be a promising adjunctive option for preventing the recurrence of CSDH. Its favorable safety profile supports its consideration in clinical settings.