title: A review of sub acute subdural hematoma (SASDH) with our institutional experience and its management by double barrel technique (DbT): A novel technique.
abstract: BACKGROUND
  Subacute subdural hematoma (SASDH) is an entity which is yet to capture the popular imagination among the neurosurgeons. Its management is often equated clinically to that of the chronic subdural hematoma (CSDH). However, their neurological deterioration is usually rapid, which seems to align them with acute subdural hematoma (ASDH). We proceed for their epidemiological evaluation. The advantages of a novel "double barrel technique (DbT)" over the conventional burrhole drainage are also presented.
  
  
  METHODS
  This retrospective study was conducted on all the patients having clinical and radiological evidence of SASDH, admitted to a tertiary care referral institute, during the period August 2013 to December 2015. Postoperatively, patients were followed-up for 3-24 months.
  
  
  RESULTS
  46.87% of the patients belonged to the 35-54 year age group with a male predominance (3.6:1); 68.7% had a history of alcohol abuse, whereas aspirin users were 25%. 87.5% cases were unilateral, 18.75% were hemispheric, and 46.87% were present on the left side. Altered consciousness (100%) followed by headache (37.5%) were the most common presenting clinical features.
  
  
  CONCLUSIONS
  SASDH is an uncommon neurosurgical entity (0.89% of traumatic brain injury cases in our study) and mimics both CSDH as well as ASDH. The true incidence of SASDH may have been underestimated due to its clinical imitation with CSDH. This study in a South Asian nation also provides the epidemiological data of this rare neurosurgical entity. Outcome of surgery is good; our retrospective study confirms that "DbT" is an adequate and safe treatment. However, a better designed, randomized control trial will be needed to reinforce our findings.
authors.affiliation: Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Soubhagya R
authors.initials: SR
authors.lastname: Tripathy
authors.affiliation: Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Pankaj K
authors.initials: PK
authors.lastname: Swarnakar
authors.affiliation: Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Sanjib
authors.initials: S
authors.lastname: Mishra
authors.affiliation: Department of Neurosurgery, VSS Institute of Medical Science and Research (VIMSAR), Burla, Sambalpur, Odisha, India.
authors.forename: Sudhanshu S
authors.initials: SS
authors.lastname: Mishra
authors.affiliation: Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Manmath K
authors.initials: MK
authors.lastname: Dhir
authors.affiliation: Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Behera
authors.affiliation: Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Pratap C
authors.initials: PC
authors.lastname: Nath
authors.affiliation: Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Somnath P
authors.initials: SP
authors.lastname: Jena
authors.affiliation: Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Itibrata
authors.initials: I
authors.lastname: Mohanta
authors.affiliation: Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Das
authors.affiliation: Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Mani C
authors.initials: MC
authors.lastname: Satapathy
authors.affiliation: Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Sitansu K
authors.initials: SK
authors.lastname: Rout
authors.affiliation: Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Bikash R
authors.initials: BR
authors.lastname: Behera
authors.affiliation: Department of Neurosurgery, Max Superspeciality Hospital, Vaishali, Uttar Pradesh, India.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Parida
authors.affiliation: Department of Obstetrics and Gynaecology, SCB Medical College, Cuttack, Odisha, India.
authors.forename: Tanushree S
authors.initials: TS
authors.lastname: Rath
keywords: Alcohol; double barrel technique; neomembrane; subacute subdural hematoma; trivial trauma