Dear Editor:

We appreciate Mr. Paraskevopoulos’s insightful commentary on our recent manuscript, “Surgical management of complex multiloculated hydrocephalus in infants and children” (Childs Nerv Syst 31:243–249, 2015). We could not agree more with the sentiment that new and creative solutions are needed to treat this challenging neurosurgical problem. While endoscopy was often paired with image guidance in the treatment of the patients in this study and previous studies [1], we have not yet routinely integrated intraoperative imaging into our treatment paradigm for multiloculated hydrocephalus. We applaud Mr. Paraskevopoulos [2] and others [37] for broadening our treatment options through the development of more advanced adjunctive surgical tools.