We conducted a systematic literature review of 111 empirical studies published between 1969 and 2018. We found that research does not exponentially grow in comparison to research on higher education or leadership; empirical research emerging in the 1980s does not completely replace non-empirical inquiry. Studies from English-speaking authors predominate. Research is characterized by the qualitative studies representative of over two thirds of publications; mixed-methods and international comparative approaches are uncommon. Altogether, 80 articles approach the person, 73 the organizational level and 30 the social context. We conclude that comparative approaches, mixed methods and a major focus on the societal environment may represent promising approaches to the study of presidential leadership. Presidential leadership research may see a desideratum in analyzing the embedded character of higher education in the wider national and international context. Future inquiry could consider university presidents’ leadership within the complex institutional environments in which the universities are embedded.