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Neurosurgical review
Jan 23, 2024;47 (1): 61.

The glymphatic system for neurosurgeons: a scoping review.

Mohammad Al Masri, Alba Corell, Isak Micha��lsson, Asgeir S Jakola, Thomas Skoglund
Author Information
  1. Mohammad Al Masri: Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  2. Alba Corell: Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ORCID
  3. Isak Micha��lsson: Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ORCID
  4. Asgeir S Jakola: Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ORCID
  5. Thomas Skoglund: Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. thomas.skoglund@gu.se. ORCID
PMID: 38253938 DOI: 10.1007/s10143-024-02291-6

Abstract

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.

Keywords

Aquaporin-4 Brain tumors Glymphatic system Head injuries Hydrocephalus Neurosurgery

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MeSH Term

Animals
Humans
Glymphatic System
Neurosurgeons
Tissue Plasminogen Activator
Brain
Subarachnoid Hemorrhage
Brain Injuries, Traumatic
Hydrocephalus
Stroke

Chemicals

Tissue Plasminogen Activator
Journal Article Scoping Review
Article has an altmetric score of 4

Word Cloud

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