Surgery is the main line of treatment for Chronic Subdural Hematoma (CSDH), and anesthesia has a great influence on the outcomes of the surgery. A previous systematic review compared general anesthesia (GA) to local anesthesia (LA) in a group of 319 subjects. In our study, we update the evidence with 3637 more cases and provide rigorous analysis.

We systematically searched five electronic databases: PubMed, Cochrane Library, Scopus, Ovid Medline, and Web of science for eligible comparative studies. All studies till October 2022 were included. Six primary outcomes were compared between the two groups. We used Review Manager Software.

Eighteen studies with a total of 4028 were included in the meta-analysis. There was no significant difference between the two techniques in terms of “recurrence rate” (OR= .95, 95% CI [0.78 to 1.15], P=0.59), “mortality rate” (OR= 1.02, 95% CI [0.55 to 1.88], P=0.96), “reoperation rate” (OR=0.95, 95% CI [0.5 to 1.79], P=0.87), local anesthesia was superior with lower “complications rate” (OR=2.4, 95% CI [1.81 to 3.17], P<0.00001). On the other hand, local anesthesia was superior with a shorter “length of hospital stay” (SMD =1.19, 95% CI [1.06 to 1.32], P<0.00001), and a shorter “duration of surgery” (SMD=0.94, 95% CI [0.67 to 1.2], P<0.00001).