Transglabellar Butterfly Incision for Anterior Cranial Vault Access: Case Report

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Please provide to extend comparison to other neurosurgical approach. Comparison with lesser invasive routes, i.e. the endonasal is poor and might be misleading. 

Can the author provide post images both of the scars and mri?

Comments on the Quality of English Language

few typos needs to be fixed. Form might be improved

Author Response

Please provide to extend comparison to other neurosurgical approach. Comparison with lesser invasive routes, i.e. the endonasal is poor and might be misleading. 

Response: Thank you for the comment. We agree. Section 3.5 has been rewritten, and alternative approaches have been addressed. The comparison to the endonasal approaches has been removed.

Can the author provide post images both of the scars and mri?

Response: we provide both postoperative MRI scans (Figure 4) and photographs (Figure 3), which indicate no residual tumour and an esthetically pleasing scar along the preexistent nasal root rhytid. Moreover, we replaced the preop MRI image (Panel B) to better show the tumor and postoperative cavity.

Comments on the Quality of English Language

few typos needs to be fixed. Form might be improved

Response: we ran the software to check for the language errors.

Reviewer 2 Report

Comments and Suggestions for Authors

Interesting case report on a trans frontal sinus approach for resection of an intraaxial brain tumor. The manuscript can be improved by adressing the following issues:

line 53: it is unclear what is meant by ablative and reconstructive possibilities (wording? language?)

line 66: cytoreductive surgery?

line 70: neurological status was normal

line 90: please provide hardware details - product, company etc.

line 130: with WHO CNS 2021 arabic numbers (WHO grade 2) are to be used

line 186: graft harvest site --> graft harvesting site or graft donor site

lines 207-212: argumentation unclear to the reader. clarify or delete passage. Also, transcribriform approaches are not the surgical method of choice for treating olfactory meningioma

lines 224-226: this passage is missing a discussion on a standard subfrontal approach (which in my view would be the appropriate alternative to the authors approach)

lines 260-262: cosmesis deserves a more detailed discussion in this manuscript and should be expanded accordingly

Comments on the Quality of English Language

see above

Author Response

Interesting case report on a trans frontal sinus approach for resection of an intraaxial brain tumor. The manuscript can be improved by adressing the following issues:

line 53: it is unclear what is meant by ablative and reconstructive possibilities (wording? Language?

Response: We have revised the sentence and the following paragraph (Lines 51-64). We believe the paragraph is now more clear.

line 66: cytoreductive surgery? Line 72

Response: We have revised the sentence (Line 71).

line 70: neurological status was normal

Response:  We have revised the sentence (Line 75).

line 90: please provide hardware details - product, company etc.

Response:  The info about NICO Myriad (Line 107), Medtronic navigation (Line 85) and Tachosil (Line 120) has already been written.

line 130: with WHO CNS 2021 arabic numbers (WHO grade 2) are to be used

Response:  We have revised the number (Line 133).

line 186: graft harvest site --> graft harvesting site or graft donor site

Response: We have revised the sentence in Line 205.

lines 207-212: argumentation unclear to the reader. clarify or delete passage. Also, transcribriform approaches are not the surgical method of choice for treating olfactory meningioma.

Response: We agree that the passage was unclear. Moreover, we extended the rationale section (revised to 3.4.). For that reason, the paragraph became redundant and we deleted it from the manuscript.

lines 224-226: this passage is missing a discussion on a standard subfrontal approach (which in my view would be the appropriate alternative to the authors approach)

Response: , and alternative approaches and alternative approaches have been used, and we agree with alternative approaches. A section of the Rationale (revised to 3.4) has been rewritten, and alternative approaches have been addressed.

lines 260-262: cosmesis deserves a more detailed discussion in this manuscript and should be expanded accordingly

Response: Thank you for the remark. We have described cosmesis in Lines 178-184, 254-258, 276-279.

Reviewer 3 Report

Comments and Suggestions for Authors

Post-operative images must be provided, both radiological and patient's image, in order to assess functional and aesthetic results.  Any opinion about the use of piezo for the craniotomy?

Author Response

Post-operative images must be provided, both radiological and patient's image, in order to assess functional and aesthetic results.  

Response: we provide both postoperative MRI scans (Figure 4) and photographs (Figure 3), which indicate no residual tumour and esthetically pleasing scar along the preexistent nasal root rhytid. Moreover, we replaced the preop MRI image (Panel B) to better show the tumor and postoperative cavity.

Any opinion about the use of piezo for the craniotomy?

Response: see 3.3. last paragraph :  A finer bone cut can be alternatively done with a piezo bone cutter or ultrasonic bone scalpel. Resorbable miniplates and screws can add to cosmesis.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

ok as edited

Reviewer 2 Report

Comments and Suggestions for Authors

Happy with the changes made

Reviewer 3 Report

Comments and Suggestions for Authors

Authors adequately answered to the reviewer's queries