1. Does Impaired Glymphatic Drainage Cause Glymphedema? A Review Tailored to Neurocritical Care and Neurosurgery
- Author
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Kern H. Guppy and Paul T. Akins
- Subjects
Decompressive Craniectomy ,medicine.medical_specialty ,Subarachnoid hemorrhage ,medicine.medical_treatment ,Neurosurgery ,Review Article ,Aquaporins ,Critical Care and Intensive Care Medicine ,Hydrocephalus (normal pressure) ,03 medical and health sciences ,Meninges ,0302 clinical medicine ,Subdural effusion ,medicine ,Humans ,In patient ,Brain injuries (traumatic) ,Intensive care medicine ,030304 developmental biology ,0303 health sciences ,Ischemic stroke ,business.industry ,Brain ,Neurointensive care ,medicine.disease ,Lymphatic system ,Hydrocephalus ,Astrocytes ,Cerebrospinal fluid circulation ,Glymphatic system ,Drainage ,Decompressive craniectomy ,Neurology (clinical) ,business ,Neurovascular coupling ,030217 neurology & neurosurgery - Abstract
Research into the glymphatic system reached an inflection point with steep trajectory in 2012 when it was formally recognized and named, but the historical roots for it are solid and deep, dating back to pioneers such as Cushing, Weed, and Dandy. We provide an overview of key discoveries of the glymphatic system, which promotes bulk flow of fluid and solutes throughout the brain parenchyma. We also discuss the lymphatic drainage of the central nervous system. Evidence is building that failure of the glymphatic system causes glymphedema in patients commonly managed by neurocritical care and neurosurgery specialists. We review research supporting this for decompressive craniectomy, subarachnoid hemorrhage, and normal-pressure hydrocephalus. We argue that it is time for a paradigm shift from the traditional model of cerebrospinal fluid circulation to a revised model that incorporates the glymphatic pathway and lymphatic clearance. These recent breakthroughs will inspire new therapeutic approaches to recognize, reverse, and restore glymphatic dysfunction and to leverage this pathway to deliver brain-wide therapeutics. more...
- Published
- 2021
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