To the Editor: We thank the authors1 for their excellent comments on our article2 and the editor for inviting us to respond. We agree with the authors that idiopathic intracranial hypertension (IIH) is a metabolic disease with many systemic manifestations. Besides patients often have risk of cardiovascular disease, presence of insulin resistance, increased truncal adiposity, hyperleptinemia, fertility, and pregnancy as you pointed out. In the clinical setting, these patients are initially seen and evaluated by neurologists and ophthalmologists. Patients with severe, refractory, or progressive symptoms, or those who do not tolerate medical management, are often referred to neurosurgeons for surgical intervention. Thus, in this article, we as neurosurgeons mainly focused on the outcomes of one of the common surgical interventions—cerebrospinal fluid shunting, rather than focusing on the diagnostic criteria. The included 15 studies were performed between 1988 and 2019, and 13 of them were published within past 20 years. In these studies, the diagnosis of IIH was generally based on “modified Dandy criteria,” which were introduced in 1985, and amended into “Friedman criteria” in 2002. At the end of the discussion, we proposed implications for a modern management protocol by combining the results of our meta-analysis with other management options through a comprehensive literature review. Indeed, at the discussion, papilledema was briefly discussed in both results of our meta-analysis and current management protocol section. In Figure 6, where we proposed current management strategy, visual symptoms and signs including papilledema were categorized into visual disturbances. We did not have extensive discussion on papilledema as the authors pointed out. There are a few reasons for that. One, in our meta-analysis, the focus was the outcomes of cerebrospinal fluid shunting, and in the modern management protocol, different management strategies were the focus. Two, as we described in the limitations of our study, some studies were performed by different specialties focusing on different outcomes. Studies reported by neurosurgeons focused on headaches and qualitative assessment of visual symptoms while ophthalmologists quantitively evaluated visual fields and visual acuity outcomes. Three, to cover all important aspects in the recommended management protocol and meanwhile not to exceed word count limit of the journal, lengthy discussions on a single aspect of the protocol were avoided. As the authors mentioned, there is indeed lack of randomized clinical trials for venous sinus stenting as a management option for idiopathic intracranial hypertension. However, many retrospective and prospective studies have shown favorable outcomes of venous sinus stenting for IIH.3-5 The meta-analysis by Nicholson et al5 reported excellent safety profile and significant improvements in headaches, pulsatile tinnitus, and papilledema after venous sinus stenting. There was moderate heterogeneity between included studies. In the end, we made a slight adjustment to figure 6 from original manuscript by taking the authors' feedback into account (Figure).FIGURE.: Adjusted current management strategy of IIH. BMI, body mass index; IIH, idiopathic intracranial hypertension.