ArticleFluids and barriers of the CNS2020
Intracranial pressure elevation alters CSF clearance pathways.
Article in Fluids and barriers of the CNS, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers.
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Who cites it
46 citing papers in PubMed, 77 citations in OpenAlex.
- Quantitative assessment of flow between cerebrospinal and interstitial fluid compartments in humans.Proceedings of the National Academy of Sciences of the United States of America · 2026Article
- Variability in the circulation of cerebrospinal fluid: causes and clinical implications for intraventricular drug delivery.Frontiers in drug delivery · 2026Review
- Computational Fluid Dynamic Model Prediction of Enhanced Glymphatic Clearance in Response to Focused Ultrasound-Mediated Blood-Brain Barrier Opening.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2025Article
- Article
- Arterial pulsations and transmantle pressure synergetically drive glymphatic flow.Scientific reports · 2025Article
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- Modeling CSF circulation and the glymphatic system during infusion using subject specific intracranial pressures and brain geometries.Fluids and barriers of the CNS · 2024Article
- CSF formation rate-a potential glymphatic flow parameter in hydrocephalus?Fluids and barriers of the CNS · 2024Article
- Improved Cerebral Glymphatic Flow after Transvenous Embolization of CSF-Venous Fistula.AJNR. American journal of neuroradiology · 2024Article
- Glymphatic and lymphatic communication with systemic responses during physiological and pathological conditions in the central nervous system.Communications biology · 2024Review
- The "microcephalic hydrocephalus" paradox as a paradigm of altered neural stem cell biology.Cerebral cortex (New York, N.Y. : 1991) · 2024Article
- Hydraulic resistance of three-dimensional pial perivascular spaces in the brain.Fluids and barriers of the CNS · 2024Article
- The nasal lymphatic route of CSF outflow: implications for neurodegenerative disease diagnosis and monitoring.Animal cells and systems · 2024Review
- Image analysis techniques for in vivo quantification of cerebrospinal fluid flow.Experiments in fluids · 2023Article
- Hydraulic resistance of three-dimensional pial perivascular spaces in the brain.Research square · 2023Article
- Cerebrospinal fluid solute transport associated with sensorimotor brain activity in rodents.Scientific reports · 2023Article
- Cerebrospinal fluid-contacting neurons: multimodal cells with diverse roles in the CNS.Nature reviews. Neuroscience · 2023Review
- Non-invasive enhancement of intracortical solute clearance using transcranial focused ultrasound.Scientific reports · 2023Article
- Image Analysis Techniques for In Vivo Quantification of Cerebrospinal Fluid Flow.bioRxiv : the preprint server for biology · 2023Article
- Pulsatile cerebral paraarterial flow by peristalsis, pressure and directional resistance.Fluids and barriers of the CNS · 2023Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundInfusion testing is a common procedure to determine whether shunting will be beneficial in patients with normal pressure hydrocephalus. The method has a well-developed theoretical foundation and corresponding mathematical models that describe the CSF circulation from the choroid plexus to the arachnoid granulations. Here, we investigate to what extent the proposed glymphatic or paravascular pathway (or similar pathways) modifies the results of the traditional mathematical models.
methodsWe used a compartment model to estimate pressure in the subarachnoid space and the paravascular spaces. For the arachnoid granulations, the cribriform plate and the glymphatic circulation, resistances were calculated and used to estimate pressure and flow before and during an infusion test. Finally, different variations to the model were tested to evaluate the sensitivity of selected parameters.
resultsAt baseline intracranial pressure (ICP), we found a very small paravascular flow directed into the subarachnoid space, while 60% of the fluid left through the arachnoid granulations and 40% left through the cribriform plate. However, during the infusion, 80% of the fluid left through the arachnoid granulations, 20% through the cribriform plate and flow in the PVS was stagnant. Resistance through the glymphatic system was computed to be 2.73 mmHg/(mL/min), considerably lower than other fluid pathways, giving non-realistic ICP during infusion if combined with a lymphatic drainage route.
conclusionsThe relative distribution of CSF flow to different clearance pathways depends on ICP, with the arachnoid granulations as the main contributor to outflow. As such, ICP increase is an important factor that should be addressed when determining the pathways of injected substances in the subarachnoid space. Our results suggest that the glymphatic resistance is too high to allow for pressure driven flow by arterial pulsations and at the same time too small to allow for a direct drainage route from PVS to cervical lymphatics.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.