Ventricular Peritoneal Shunting Using Modified Keen’s Point Approach: Technical Report and Cases Series
, Daniele Bongetta 1, Fabio Cofano 2, Alessandro Versace 1, Diego Garbossa 2, Alessandro Bertuccio 3, Daniele Armocida 4, Patrizia d’Auria 5, Lisa Maria Farina 6, Roberto Assietti 1 and Fulvio Tartara 6
Michael McDowell
Round 1
Reviewer 1 Report
Colombo et al report a study on parietal VPS placement via Keens point. 188 shunts were placed with 11% requiring revision during follow-up on average of about 2 years. I would advise caution with the concept of temporal access. This is neither the temporal bone nor the temporal pole proper. It is the parietal bone (maybe occipital) and the atrium and the inferior parietal lobule. There are data to suggest that placement within the temporal horn results in a higher rate of malfunction. I would advise avoiding any association with this. The reality is the images, both external and radiographic, show a minimal variant Keen’s point technique. Slight variations in measurement do not justify a new name for what has always been an inferior parietal boss approach. The location being described is also very similar to this reviewer’s “take” on keen’s point, which is my preferred placement for new shunts. Nonetheless, I do agree that there is insufficient literature on parietal shunts and I do think this is worthy of publication, pending more toned down terminology “(modified Keen’s point approach” at most).
The authors should have a summary table or set of tables with primary data points.
The authors should add https://pubmed.ncbi.nlm.nih.gov/30627679/ to their comparisons as this represents a similar size cohort of parietal shunts
Author Response
Dear Reviewer, thank you for your comments.
Following your comments, I modified the "name" of the approach and I added the reference you suggested. I also summarized the results and epidemiological data in Table 1.
Hoping to have improved the quality of the manuscript.
Kind regards,
EV Colombo
Reviewer 2 Report
The paper is well written and shows their experience about posterior temporal approach for ventricular-peritoneal shunting, that seems to be safe and technically feasible. Paper can be suitable for publication.
Author Response
Thank you for your comments
