Chronic Subdural Hematoma Drainage under Local versus General Anesthesia: Systematic Review and Meta-Analysis

Abstract

BackgroundChronic subdural hematoma (CSDH) is one of the most frequently encountered neurosurgical conditions. Although mainstay treatment of cSDH has been burr hole drainage, no consensus yet exists on optimal anesthetic strategy between general (GA) and local (LA) anesthesia. This systematic review compares post-operative outcomes after CSDH evacuation under LA and GA. MethodsA search was conducted in MEDLINE (1946 to November 2022), Embase (1974 to November 2022), and PubMed (up to November 2022). We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to systematically screen studies. ResultsOur literature search identified 629 studies, out of which 12 were included. There were a total of 1035 patients in the LA group and 699 patients in the GA group. Our meta-analysis found that the LA group had significant shorter operative time (mean difference -29.28 minutes, p <0.0001), length of admission (Mean difference -1.58 days, 95% CI = -2.40 to -0.76 days, p = 0.0002), and postoperative complications rate (odds ratio 0.38, 95% CI = 0.25 to 0.59, p < 0.0001) compared to GA. There was no significant difference between the two groups in revision rate (odds ratio 0.77, 95% CI 0.39 to 1.51, p = 0.45) and mortality rate (odds ratio 1.23, 95% CI 0.63 to 2.43, p = 0.55). ConclusionsIn this meta-analysis, LA shows benefits in shorter operative time, shorter admission length, and fewer postoperative complications. This makes local anesthesia a less invasive alternative to general anesthesia, especially in elderly patients.