The glymphatic system for neurosurgeons: a scoping review.
Mohammad Al MasriAlba CorellIsak MichaëlssonAsgeir Store JakolaThomas SkoglundPublished in: Neurosurgical review (2024)
The discovery of the glymphatic system has revolutionized our understanding of cerebrospinal fluid (CSF) circulation and interstitial waste clearance in the brain. This scoping review aims to synthesize the current literature on the glymphatic system's role in neurosurgical conditions and its potential as a therapeutic target. We conducted a comprehensive search in PubMed and Scopus databases for studies published between January 1, 2012, and October 31, 2023. Studies were selected based on their relevance to neurosurgical conditions and glymphatic function, with both animal and human studies included. Data extraction focused on the methods for quantifying glymphatic function and the main results. A total of 67 articles were included, covering conditions such as idiopathic normal pressure hydrocephalus (iNPH), idiopathic intracranial hypertension (IIH), subarachnoid hemorrhage (SAH), stroke, intracranial tumors, and traumatic brain injury (TBI). Significant glymphatic dysregulation was noted in iNPH and IIH, with evidence of impaired CSF dynamics and delayed clearance. SAH studies indicated glymphatic dysfunction with the potential therapeutic effects of nimodipine and tissue plasminogen activator. In stroke, alterations in glymphatic activity correlated with the extent of edema and neurological recovery. TBI studies highlighted the role of the glymphatic system in post-injury cognitive outcomes. Results indicate that the regulation of aquaporin-4 (AQP4) channels is a critical target for therapeutic intervention. The glymphatic system plays a critical role in the pathophysiology of various neurosurgical conditions, influencing brain edema and CSF dynamics. Targeting the regulation of AQP4 channels presents as a significant therapeutic strategy. Although promising, the translation of these findings into clinical practice requires further human studies. Future research should focus on establishing non-invasive biomarkers for glymphatic function and exploring the long-term effects of glymphatic dysfunction.
Keyphrases
- traumatic brain injury
- subarachnoid hemorrhage
- cerebrospinal fluid
- cerebral ischemia
- case control
- endothelial cells
- randomized controlled trial
- clinical practice
- blood pressure
- systematic review
- type diabetes
- atrial fibrillation
- oxidative stress
- white matter
- small molecule
- adipose tissue
- blood brain barrier
- insulin resistance
- machine learning
- heavy metals
- current status
- resting state
- metabolic syndrome
- skeletal muscle
- human health
- data analysis
- optical coherence tomography