Dear Editor

Thank you very much for your excellent review and comments. It has definitely helped to strengthen my
article.
Please find the queries answered. The corrected article is also attached.

The content of your article seem interesting, however our review have raised few concerns which need
your consideration.

 How was the sample size calculated?

 Consecutive cases that fit in the criteria were included
 The study would look more powered if statistical analysis can be done!
 Basic only done. Will plan with larger study
 To avoid herniation with use of lumbar drain, what was selection criteria used as mentioned in
discussion? Were only communicating hydrocephalus included in the study?
 Only communication hydrocephalus was included
 Since DH is delayed hydrocephalus, it seems author have not included any cases with
Hydrocephalus at presentation with SAH
 Hydrocephalus at admission was excluded from the study
 Methodology of lumbar drain: how was the drain controlled to drain only 15-20ml/hr? Did the
Duration of lumbar drain vary in each case? 
 Graduated drainage system was used to calculate the hourly CSF drain. On an average
the days were similar as mentioned in the text.
 How many pt had LD accidentally removed during back or bed care or mobilisation?
 None. Double tape and fixation to skin was used in all cases
 Were all these patients consecutively recruited in the study or some patient with poor neurological
status underwent direct VP shunting?
 Consecutively recruited
 What was the endpoint of the study: need of VP shunt/ death/ no Hydrocephalus after certain
period?
 Absence of hydrocephalus with use of lumbar drain
 Were the patient worked up for Meningitis as LD was kept for it seems more than 6 days?
 CSF study was done every 3 days.
 Hydrocephalus can occur in post decompressive craniectomy cases which usually responds to
lumbar drain. It however corrects after cranioplasty. How do author clarify this occurrence with
successful results after traumatic SAH? How many patient underwent cranioplasty prior to VP
shunt?
 All cases underwent cranioplasty but at a later date during follow-up.
 Spelling mistake: “Fischer scare” in place of “Fischer scale”
 done
 Missing: Abstract Results: Fischer score in aneurysm...
 done
 Did all the patients with traumatic SAH underwent surgery?
 No
 Type of hydrocephalus in each category is not mentioned?
 Its in the inclusion criteria. DH only, communicating type.
 What prophylactic surgical maneuvers were adopted in the cases to prevent hydrocephalus? can
they create any biases in the outcome? please mention about them! 
 None except for opening of the Lamina terminalis which was performed for immediate
brian relaxation. But this could affect the outcome which has not been studied. Mentioned
in the limitations.
 Please use "Fisher grade" rather than "Fischer Scale”
  OK
 Was the patient manages in ICU or general ward?
 Post-operative ward for 2 days and the General.
 In results, author say cost effective however keeping a patient for over a week on lumbar drain
can put financial burden and besides author does not present any cost comparison analysis on
this aspect. Keeping a patient bedridden for these may days, exposes the person to DVT or
pneumonia or bed sore!
 Its at the end of the article. Cost of VP shunt and LD. Five to six days remain the same
for both procedures hence no difference.
 Leptomeningeal proliferation or arachnoidal fibrosis/ adhesions which occur late after SAH, does
not clear by lumbar draining only, how to explain 92.5% success rate in your series?
 This study showed the absence of DH by LD in the majority and ehce the conlusion
 References 29 to 31 relates with early use of prophylactic lumbar drainage, this actually
contaminates your discussion on late use of lumbar drains. Besides reference 31 is missing in the
bibliography!
 Its for the other uses of LD in SAH and the beneficial affects in vasospasm. Reference
has been added.
 Mention the one failure which occurred with case of acute SDH in the results rather than
discussion!
 OK