Middle meningeal artery embolization in patients treated with Japanese Kampo Goreisan for recurrent chronic subdural hematoma: a prospective cohort comparative study.

Abstract

Adjuvant middle meningeal artery embolization (MMAE) after burr-hole drainage for chronic subdural hematoma (CSDH) has emerged as a promising strategy. However, in Japan, MMAE is not covered by national health insurance; thus, it has been reserved for patients with recurrent CSDHs after burr-hole drainage. Goreisan has been reported to lower the incidence of recurrent CSDHs. Hence, we investigated the synergistic effect of MMAE and Goreisan in patients with recurrent CSDH. We prospectively included patients with recurrent CSDHs who received Goreisan after burr-hole drainage and separated them into groups based on whether MMAE was performed (group B + G + MMAE) or not (group B + G). Out of 605 patients who underwent burr-hole drainage for CSDHs, groups B + G and B + G + MMAE comprised 20 and 34 consecutive patients, respectively. Patient characteristics, such as age, sex, antithrombotic medications, history of blood coagulopathy disorders, and the modified Rankin scale (mRS) scores before symptom onset, did not differ between the two groups. No significant differences in the incidence of re-recurrent CSDHs (5% and 5.8%, in groups B + G and B + G + MMAE, p > 0.05, respectively) and favorable functional outcome (mRS score ≤ 2) at 3-month retreatment (90% and 76.5% in groups B + G and B + G + MMAE, p > 0.05, respectively) were found in the two groups 3 months post-retreatment. A positive effect of MMAE in preventing the re-recurrence of CSDHs in patients treated with Goreisan for recurrent CSDHs was not observed.