{
  "abstract": "Background: Chronic subdural haematoma (cSDH) is a common neurosurgical condition, many patients have significant comorbidity or are living with frailty. Surgery is effective and can be performed under local anaesthesia (with or without sedation) (LAS) or general anaesthesia (GA). Optimal technique for both GA and LAS is poorly defined but similar questions have been explored in other surgical settings. We sought to clarify the breadth of evidence for anaesthetic technique in cSDH surgery, while drawing on relevant literature from other disciplines to understand how a definitive trial of this question could be performed.\n\nMaterials and methods: We used a combination of review of trial registries, the Cochrane database, and a survey of anaesthetic and neurosurgical practitioners.\n\nResults: We identified a paucity of high-quality studies, especially randomised trials, exploring this question. The literature, and survey of anaesthetists and surgeons suggest that LAS may achieve equivalent outcomes, but significant confounding exists in current studies. Registered trials are single centre, and Cochrane reviews in other fields present issues of equipoise, study design, and outcome choice as key challenges in designing a definitive trial.\n\nConclusions: There is significant interest in this topic as evidenced by published and emerging literature and views of anaesthetists and surgeons. No registered trial is multi-centre or draws on challenges identified in similar trials from other disciplines.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00701-026-06982-5.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Perioperative, Acute, Critical Care, and Emergency Medicine (PACE) Section, University of Cambridge, Cambridge, CB2 0SZ UK",
    "Department of Neurosurgery, Addenbrooke’s Hospital, Cambridge, UK",
    "Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK",
    "Department of Neurosurgery, King’s College Hospital, London, UK",
    "Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK",
    "Royal College of Surgeons of Ireland, Dublin, Republic of Ireland",
    "Department of Medicine, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK",
    "Department of Neurosurgery, Hull Teaching Hospitals, Hull, UK",
    "Department of Neuroanaesthesia, St George’s Hospital, London, UK",
    "Academic Unit of Injury, Inflammation and Repair, University of Nottingham, Nottingham, UK",
    "Consultant Anaesthetist, Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK",
    "Department of Neuroanaesthesia, University College London Hospitals NHS Foundation Trust, London, UK",
    "Department of Neurosurgery, South West Neurosurgical Centre, Plymouth, UK"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 35,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Daniel J. Stubbs"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Conor S. Gillespie"
    },
    {
      "affs": [
        0
      ],
      "name": "Matthew L. Watson"
    },
    {
      "affs": [
        0
      ],
      "name": "Basil Nourallah"
    },
    {
      "affs": [
        0
      ],
      "name": "Caroline M. Phillips"
    },
    {
      "affs": [
        0
      ],
      "name": "George Gathercole"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Jamie Brannigan"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Keng Siang Lee"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Orla Mantle"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Vian Omar"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Adele Mazzoleni"
    },
    {
      "affs": [
        5
      ],
      "name": "Githmi Palahepitiya Gamage"
    },
    {
      "affs": [
        6
      ],
      "name": "Alvaro Yanez Touzet"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Munashe Veremu"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Youssef Chedid"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "William H. Cook"
    },
    {
      "affs": [
        0
      ],
      "name": "Karanjit Loyal"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Gideon Adegboyega"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Oliver D. Mowforth"
    },
    {
      "affs": [
        7
      ],
      "name": "Edward Goacher"
    },
    {
      "affs": [
        0
      ],
      "name": "Apoorva Singh"
    },
    {
      "affs": [
        0
      ],
      "name": "Jonathan P. Coles"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Alexis Joannides"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Angelos Kolias"
    },
    {
      "affs": [
        8
      ],
      "name": "Judith Dinsmore"
    },
    {
      "affs": [
        9,
        10
      ],
      "name": "Iain Moppett"
    },
    {
      "affs": [
        10
      ],
      "name": "Michael Nathanson"
    },
    {
      "affs": [
        11
      ],
      "name": "Sally R. Wilson"
    },
    {
      "affs": [
        0
      ],
      "name": "Amit Deshmukh"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Edoardo Viaroli"
    },
    {
      "affs": [
        0
      ],
      "name": "David K. Menon"
    },
    {
      "affs": [
        12
      ],
      "name": "Ellie Edlmann"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Benjamin M. Davies"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Peter J. Hutchinson"
    },
    {
      "name": "Improving Care In Elderly Neurosurgery Initiative (ICENI) Working Group"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4tmb6492nw9h8.bib",
  "cited_by": 0,
  "doi": "10.1007/s00701-026-06982-5",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13696589/",
  "id": "4tmb6492nw9h8",
  "issns": [
    "0001-6268",
    "0942-0940"
  ],
  "landing_url": "https://doi.org/10.1007/s00701-026-06982-5",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review"
    ],
    [
      "openalex",
      "2728|Neurosurgical Procedures and Complications"
    ]
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  "openalex": "W7171532315",
  "pdf_url": "https://europepmc.org/articles/PMC13696589?pdf=render",
  "pmcid": "PMC13696589",
  "pmid": "42928394",
  "published": "2026-07-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/4tmb6492nw9h8.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:55Z",
      "native_id": "PMC13696589",
      "source": "pmc",
      "url": "https://doi.org/10.1007/s00701-026-06982-5"
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    {
      "first_seen": "2026-10-30T12:21:20Z",
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      "url": "https://europepmc.org/article/MED/42928394"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Neurosurgical Procedures and Complications",
      "subfield": "neurology"
    }
  ],
  "title": "Need for a definitive trial of local versus general anaesthesia in chronic subdural haematoma; survey and literature review of ongoing trials",
  "title_text": "Need for a definitive trial of local versus general anaesthesia in chronic subdural haematoma; survey and literature review of ongoing trials",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:33:54Z",
  "url": "https://research.draconitic.com/paper/4tmb6492nw9h8",
  "venue": "Acta Neurochirurgica",
  "versions": []
}