Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
College of Medicine, University of Nebraska, Omaha, Nebraska, USA.
World Neurosurg. 2024 Oct;190:147-156. doi: 10.1016/j.wneu.2024.07.062. Epub 2024 Jul 11.
Cerebrospinal fluid (CSF) circulates throughout the ventricles, cranial and spinal subarachnoid spaces, and central spinal cord canal. CSF protects the central nervous system through mechanical cushioning, regulation of intracranial pressure, regulation of metabolic homeostasis, and provision of nutrients. Recently, investigators have characterized the glial-lymphatic (glymphatic) system, the analog of the lymphatic system in the central nervous system, and described a fourth meningeal layer; the subarachnoid lymphatic-like membrane (SLYM)relevant to the CSF.
A narrative review was conducted.
In this review, we summarize these advances. We describe the development of the original model, controversies, a revised model, and a new conceptual framework. We characterize the biological functions, influence of sleep-wake cycles, and effect of aging with relevance to the glymphatic system. We highlight the role of the glymphatic system in Alzheimer's disease, idiopathic normal pressure hydrocephalus, ischemic stroke, subarachnoid hemorrhage, and traumatic brain injury. Next, we characterize the structure and role of the SLYM. Finally, we explore the relevance of the glymphatic system and SLYM to neurosurgery.
This manuscript will inform clinicians and scientists regarding preclinical and translational advances in the understanding of the structure, dynamics, and function of the CSF.
脑脊液（CSF）在脑室、颅腔和脊髓蛛网膜下腔以及中央脊髓管中循环。CSF 通过机械缓冲、调节颅内压、调节代谢稳态和提供营养来保护中枢神经系统。最近，研究人员描述了神经胶质 - 淋巴（glymphatic）系统，即中枢神经系统的类似淋巴系统，并描述了第四脑膜层；蛛网膜下腔类似淋巴的膜（SLYM）与 CSF 相关。
进行了叙述性综述。
在这篇综述中，我们总结了这些进展。我们描述了原始模型的发展、争议、修订模型和新的概念框架。我们描述了生物学功能、睡眠 - 觉醒周期的影响以及与 glymphatic 系统相关的衰老的影响。我们强调了 glymphatic 系统在阿尔茨海默病、特发性正常压力脑积水、缺血性中风、蛛网膜下腔出血和创伤性脑损伤中的作用。接下来，我们描述了 SLYM 的结构和作用。最后，我们探讨了 glymphatic 系统和 SLYM 与神经外科的相关性。
本文将为临床医生和科学家提供有关 CSF 结构、动力学和功能的理解的临床前和转化进展的信息。
