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Background:   The aim of this study was to assess the safety and efficacy of chronic subdural hematoma (CSDH) evacuation by two burr-hole craniostomies under local versus general anesthesia (GA) in elderly patients over 70 years.    Methods:   This retrospective study included 45 patients with CSDH aged over 70 years old treated from March 2018 to April 2020. The cases were subdivided into Group A ( n  = 22) that underwent evacuation under local anesthesia and Group B ( n  = 23) that was treated under GA. Patients’ demographics and history of comorbidities were recorded. Variables including pre- and post-operative neurological status and Markwalder’s score, complication rate, operative time, and length of hospital stay were evaluated.    Results:   The mean and standard deviation of patients’ age of groups (A) and (B) were 74.3 ± 2.5 and 73.2 ± 1.7 years, respectively. Postoperative Glasgow Coma Scale of group (A) was statistically higher than Group B at postoperative day 1 ( P  = 0.01). Operative time was statistically shorter in Group A than B ( P  &lt; 0.0001). The length of hospital stay was found to be longer in group (B) than (A) ( P  = 0.0001). The complication rate was found to be higher in group (B) than (A) ( P  = 0.044).    Conclusion:   Evacuation of CSDH under local anesthesia in elderly patients over 70 years is effective, safe, and economic with less complication rate than the traditional technique with GA.

Local anesthesia versus general anesthesia for evacuation of chronic subdural hematoma in elderly patients above 70 years old