Sukwoo Hong, Yuki Shinya
This meta-analysis did not demonstrate a significant benefit of Goreisan in reducing surgical intervention for minimally symptomatic CSDH. Additional high-quality studies are warranted to clarify its potential efficacy and to address heterogeneity (PROSPERO CRD420251118315).
OBJECTIVES: Goreisan is a traditional herbal medicine composed of five active ingredients, and our previous meta-analysis demonstrated a significant reduction in recurrence after surgery for chronic subdural hematoma (CSDH). However, its effect in nonsurgical cases remains unclear. This systematic review and meta-analysis aimed to evaluate its effectiveness in the management of minimally symptomatic, nonoperative CSDH.
METHODS: Following PRISMA guidelines, we included studies assessing Goreisan for nonoperative CSDH management. PubMed, Cochrane Library, Embase, Google Scholar, and ICHUSHI were searched from inception to August 2025. The primary outcome was the rate of surgical intervention. Heterogeneity was assessed using the I2 statistic.
RESULTS: Seven studies (two comparative studies and five single-arm studies) involving 356 patients (241 received Goreisan; 115 did not) met the inclusion criteria. All patients received 7.5 g/day of Goreisan for 1-12 months. In comparative studies, the surgical intervention rate was not significantly lower in the Goreisan group than in the control group (12/43 [28%] vs. 42/115 [37%]; odds ratio, 0.55 [95% confidence interval [CI]: 0.13-2.38]; I2 = 63%). In single-arm studies, the pooled surgical intervention rate was 0.15 (95% CI: 0.10-0.21; I2 = 0%).
CONCLUSIONS: This meta-analysis did not demonstrate a significant benefit of Goreisan in reducing surgical intervention for minimally symptomatic CSDH. Additional high-quality studies are warranted to clarify its potential efficacy and to address heterogeneity (PROSPERO CRD420251118315).