Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Nydalen, Pb 4950 N-0424, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Acta Neurochir (Wien). 2024 Jun 21;166(1):274. doi: 10.1007/s00701-024-06161-4.
The discovery of the glymphatic system has fundamentally altered our comprehension of cerebrospinal fluid transport and the removal of waste from brain metabolism. In the past decade, since its initial characterization, research on the glymphatic system has surged exponentially. Its potential implications for central nervous system disorders have sparked significant interest in the field of neurosurgery. Nonetheless, ongoing discussions and debates persist regarding the concept of the glymphatic system, and our current understanding largely relies on findings from experimental animal studies. This review aims to address several key inquiries: What methodologies exist for evaluating glymphatic function in humans today? What is the current evidence supporting the existence of a human glymphatic system? Can the glymphatic system be considered distinct from the meningeal-lymphatic system? What is the human evidence for glymphatic-meningeal lymphatic system failure in neurosurgical diseases? Existing literature indicates a paucity of techniques available for assessing glymphatic function in humans. Thus far, intrathecal contrast-enhanced magnetic resonance imaging (MRI) has shown the most promising results and have provided evidence for the presence of a glymphatic system in humans, albeit with limitations. It is, however, essential to recognize the interconnection between the glymphatic and meningeal lymphatic systems, as they operate in tandem. There are some human studies demonstrating deteriorations in glymphatic function associated with neurosurgical disorders, enriching our understanding of their pathophysiology. However, the translation of this knowledge into clinical practice is hindered by the constraints of current glymphatic imaging modalities.
脑脊液系统的发现从根本上改变了我们对脑脊髓液运输和大脑代谢废物清除的理解。在过去的十年中，自最初的特征描述以来，对脑脊液系统的研究呈指数级增长。其对中枢神经系统疾病的潜在影响引起了神经外科学界的极大兴趣。尽管如此，关于脑脊液系统的概念仍在持续讨论和争论，我们目前的理解主要依赖于实验动物研究的发现。本综述旨在探讨几个关键问题：目前有哪些评估人类脑脊液功能的方法？支持人类存在脑脊液系统的现有证据是什么？脑脊液系统能否被认为与脑膜淋巴系统不同？在神经外科疾病中，人类脑脊液-脑膜淋巴系统衰竭的证据是什么？现有文献表明，目前用于评估人类脑脊液功能的技术很少。到目前为止，鞘内对比增强磁共振成像（MRI）显示出最有前途的结果，并为人类存在脑脊液系统提供了证据，尽管存在一些局限性。然而，必须认识到脑脊液系统和脑膜淋巴系统之间的相互联系，因为它们是协同运作的。有一些人类研究表明，与神经外科疾病相关的脑脊液功能恶化，丰富了我们对其病理生理学的理解。然而，由于目前脑脊液成像模式的限制，将这些知识转化为临床实践受到阻碍。
