Burr-hole craniostomy under local versus general anesthesia: Comparative outcomes in elderly patients with chronic subdural hematoma

Chronic subdural hematoma (CSDH) is a common neurosurgical condition predominantly affecting elderly patients. While surgical evacuation remains the standard treatment, the optimal anesthetic approach for this vulnerable population remains debatable. This study aimed to compare the clinical outcomes and perioperative complications between local anesthesia (LA) and general anesthesia (GA) in elderly patients undergoing CSDH evacuation. We conducted a retrospective cohort study of patients aged ≥65 years who underwent surgical evacuation of CSDH between January 2018 and December 2022. Patients were divided into LA and GA groups. Primary outcomes included operative time, length of hospital stay, and perioperative complications. Secondary outcomes included recurrence rates, neurological improvement, and 30-day mortality. Propensity score matching was performed to minimize selection bias. A total of 286 patients were included (LA 142, GA 144) in the analysis. The LA group demonstrated significantly shorter operative times (45.3±12.6 vs 68.7±15.4 minutes, p0.001) and reduced length of hospital stay (4.2±1.8 vs 6.5±2.3 days, p0.001). Perioperative complications were lower in the LA group (12.7% vs 23.6%, p=0.015), particularly regarding respiratory complications and postoperative cognitive dysfunction. No significant differences were observed in recurrence rates (LA 9.2% vs GA 10.4%, p=0.724) or neurological improvement (LA 85.9% vs GA 83.3%, p=0.568). The 30-day mortality rate was comparable between groups (LA 2.1% vs GA 2.8%, p=0.712). Local anesthesia for CSDH evacuation in elderly patients is associated with shorter operative times, reduced hospital stay, and fewer perioperative complications compared to general anesthesia.