Purpose <p>Chronic subdural hematoma (cSDH) is a highly prevalent condition that frequently requires surgical evacuation. This is typically achieved through burr hole evacuation, which can be performed under either local anesthesia (LA) or general anesthesia (GA). In the present study, we provide a systematic review and meta-analysis to study and compare the safety and efficacy of cSDH evacuation in LA and GA.</p> Methods <p>Following the PRISMA guidelines, we screened four databases for studies that compared postoperative outcomes after burr hole evacuation of cSDH in LA versus GA. Baseline characteristics and postoperative outcome data were collected, and risk ratios were calculated for each study as well as pooled across records. Random effect models were applied to continuous data points. Bias was assessed using the MINORS tool.</p> Results <p>We identified 22 eligible studies covering 3917 patients in total. LA was associated with decreased risk for complications (p &lt; 0.001), shorter surgery duration (p &lt; 0.001) and hospital stay (p &lt; 0.001). There was no statistically significant association with recurrence rates, postoperative seizure or occurrence of pneumocephalus. In a subanalysis including only data from studies utilizing subdural drainage, results remained largely similar with LA proving advantageous in terms of shorter surgery duration (p &lt; 0.001) and hospital stay (p &lt; 0.001).</p> Conclusion <p>LA may serve as a safe alternative to GA for cSDH surgery, associated with fewer postoperative complications and providing benefits regarding shorter hospital stay and surgery duration.</p>