Response to “Commentary on “Arachnoid cysts of the quadrigeminal cistern: Proposal of a therapeutic algorithm based on a systematic review of literature””

Abstract

Response to the letter Dear Dr. Luca Massimi Title: Response to the commentary regarding “Arachnoid cysts of the quadrigeminal cistern: Proposal of a therapeutic algorithm based on a systematic review of literature” by Ferreira Furtado et al. We appreciate your consideration of our manuscript and for sharing reviewer’s comments, which would add relevant information for the readers and enhance the discussion of this enthusiastic theme. Indeed, the quadrigeminal arachnoid cysts (QACs) are positioned on the core of encephalon and its management is challenging. Owing to this rarity, there is a paucity of evidence in the literature as well you postulated. We thank you for the comment regarding the shape of QACs and its relationship with the occurrence of aqueduct compression and an increased risk of developing hydrocephalus. In fact, a description of the anatomy of the quadrigeminal cistern allows the reader to understand the physiopathology of hydrocephalus and better surgical approaches. To our knowledge, further studies are required to investigate the variations in the shapes of QACs in order to quantify such risks. Moreover, we found that your experience of effectiveness is valid even in younger patients. Nevertheless, because of the incipient maturation aspects of cerebrospinal fluid pathway before sixth month, certain evidences of recurrence of QACs as per previous studies, and sufficient evidence to corroborate otherwise, the decision to consider age and the option of coagulation of choroid plexus is consistent with the large series of hydrocephalus treatment. [1] Choroid plexus coagulation in the context of QACs intends to increase the chance to control the hydrocephalus and reduce recurrence in this group of patients. Furthermore, to our knowledge, this proposed algorithm plays a role in compiling some findings and is limited due to the rarity of this disease. Therefore, we are aware that it will be required to contribute to this field of knowledge and further studies will help in achieving better evidences. Best regards Leopoldo M Furtado et al