Full-Thickness Craniodural Metastasis with Leptomeningeal Infiltration of Salivary Origin: A Radiological Lesson and a Technical Remark

Round 1

Reviewer 1 Report

This study aims to present review of diagnosis and management of full thickness craniodural metastasis of undifferentiated salivary adenocarcinoma. The case study is quite interesting, however, the manuscript content need to be improved. There are some issues that need to be considered.

-        where the primary site of undifferentiated salivary adenocarcinoma was located? In case description, the Authors mentioned of history of left submandibular gland (major salivary gland) excision with neck dissection (ND). However, in discussion, the Authors wrote that this was dissemination of carcinoma of minor salivary gland.

-          What was the range of ND (cervical lymph node levels)? Is there any neck metastasis?

-          The authors did not mention about radicality of the excision (metastasectomy) and eventual postoperative (adjuvant) treatment.

-          In the title should be “metastasis” instead of “metastases”.

-          The follow-up is very short (30 days).

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

The authors describe a rare case of calvarial metastasis from minor salivatory gland tumor.

I find this case moderately interesting. The presentation of calvarial metastasis in the setting of minor salivatory gland tumors is unquestionably rare, although not surprising in the context of multimetastatic disease involving bone structures.

The case is well presented. Although the patients did not perform contrast-enhanced MRI or CT due to allergy, the images are explicative.

I do not have any major concerns with the presented case.

I suggest to include a table describing the common sites of metastases for minor salivatory gland tumors, with the respective percentage if known.

Please review the manuscript for english typos and sentence structure (for example line 32 could be corrected to "Metastases spread to the calvarium via three 3 routes")

Author Response

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Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Thank you for your response. Only two minor corrections are required:

-          In the line 102 should be “gland” instead of “glands”.

-          In the line 51 should be “unilateral” or “ipsilateral” instead of “monolateral”. Still there is no information about the range of ND. It was selective neck dissection (SND), modified radical neck dissection (MRND) or radical neck dissection (RND)?

Author Response

Please see the attachment

Author Response File: Author Response.docx