Need for a definitive trial of local versus general anaesthesia in chronic subdural haematoma; survey and literature review of ongoing trials
13 affiliations
- 1Department of Perioperative, Acute, Critical Care, and Emergency Medicine (PACE) Section, University of Cambridge, Cambridge, CB2 0SZ UK
- 2Department of Neurosurgery, Addenbrooke’s Hospital, Cambridge, UK
- 3Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- 4Department of Neurosurgery, King’s College Hospital, London, UK
- 5Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- 6Royal College of Surgeons of Ireland, Dublin, Republic of Ireland
- 7Department of Medicine, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
- 8Department of Neurosurgery, Hull Teaching Hospitals, Hull, UK
- 9Department of Neuroanaesthesia, St George’s Hospital, London, UK
- 10Academic Unit of Injury, Inflammation and Repair, University of Nottingham, Nottingham, UK
- 11Consultant Anaesthetist, Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
- 12Department of Neuroanaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
- 13Department of Neurosurgery, South West Neurosurgical Centre, Plymouth, UK
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.
Materials and methods: We used a combination of review of trial registries, the Cochrane database, and a survey of anaesthetic and neurosurgical practitioners.
Results: 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.
Conclusions: 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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00701-026-06982-5.
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BibTeX
@article{stubbs2026need,
title = {{Need for a definitive trial of local versus general anaesthesia in chronic subdural haematoma; survey and literature review of ongoing trials}},
author = {Daniel J. Stubbs and Conor S. Gillespie and Matthew L. Watson and Basil Nourallah and Caroline M. Phillips and George Gathercole and Jamie Brannigan and Keng Siang Lee and Orla Mantle and Vian Omar and Adele Mazzoleni and Githmi Palahepitiya Gamage and Alvaro Yanez Touzet and Munashe Veremu and Youssef Chedid and William H. Cook and Karanjit Loyal and Gideon Adegboyega and Oliver D. Mowforth and Edward Goacher and Apoorva Singh and Jonathan P. Coles and Alexis Joannides and Angelos Kolias and Judith Dinsmore and Iain Moppett and Michael Nathanson and Sally R. Wilson and Amit Deshmukh and Edoardo Viaroli and David K. Menon and Ellie Edlmann and Benjamin M. Davies and Peter J. Hutchinson and Improving Care In Elderly Neurosurgery Initiative (ICENI) Working Group},
journal = {Acta Neurochirurgica},
year = {2026},
month = jul,
doi = {10.1007/s00701-026-06982-5},
url = {https://doi.org/10.1007/s00701-026-06982-5},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Need for a definitive trial of local versus general anaesthesia in chronic subdural haematoma; survey and literature review of ongoing trials
AU - Daniel J. Stubbs
AU - Conor S. Gillespie
AU - Matthew L. Watson
AU - Basil Nourallah
AU - Caroline M. Phillips
AU - George Gathercole
AU - Jamie Brannigan
AU - Keng Siang Lee
AU - Orla Mantle
AU - Vian Omar
AU - Adele Mazzoleni
AU - Githmi Palahepitiya Gamage
AU - Alvaro Yanez Touzet
AU - Munashe Veremu
AU - Youssef Chedid
AU - William H. Cook
AU - Karanjit Loyal
AU - Gideon Adegboyega
AU - Oliver D. Mowforth
AU - Edward Goacher
AU - Apoorva Singh
AU - Jonathan P. Coles
AU - Alexis Joannides
AU - Angelos Kolias
AU - Judith Dinsmore
AU - Iain Moppett
AU - Michael Nathanson
AU - Sally R. Wilson
AU - Amit Deshmukh
AU - Edoardo Viaroli
AU - David K. Menon
AU - Ellie Edlmann
AU - Benjamin M. Davies
AU - Peter J. Hutchinson
AU - Improving Care In Elderly Neurosurgery Initiative (ICENI) Working Group
PY - 2026
DA - 2026/07/28
JO - Acta Neurochirurgica
DO - 10.1007/s00701-026-06982-5
UR - https://doi.org/10.1007/s00701-026-06982-5
AB - 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. Materials and methods: We used a combination of review of trial registries, the Cochrane database, and a survey of anaesthetic and neurosurgical practitioners. Results: 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. Conclusions: 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00701-026-06982-5.
SN - 0001-6268
SN - 0942-0940
ER -