ReviewCellular and molecular life sciences : CMLS2021
Cerebrospinal fluid outflow: a review of the historical and contemporary evidence for arachnoid villi, perineural routes, and dural lymphatics.
Review in Cellular and molecular life sciences : CMLS, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06857136 (The Role of the Glymphatic System Avaluated Thourgh mr Imaging in the Diagnosis and Management of NPH), which is not on this map. Cited by 246 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Role of the Glymphatic System Avaluated Thourgh mr Imaging in the Diagnosis and Management of NPH
Who cites it
246 citing papers in PubMed, 3 syntheses or guidelines pooled it, 382 citations in OpenAlex.
- Brain lymphatic drainage pathways, deep cervical lymphatic surgery, and current insights: A systematic review.The journal of prevention of Alzheimer's disease · 2026Pooled it
- From glia limitans to glial scars: in vitro co-culture studies of the astrocyte and meningeal interaction.Fluids and barriers of the CNS · 2025Pooled it
- CSF hypersecretion versus impaired CSF absorption in posthemorrhagic hydrocephalus: a systematic review.Acta neurochirurgica · 2023Pooled it
- Redefining intranasal brain delivery: from nasal entry to meaningful parenchymal and cellular exposure.Drug delivery · 2026Review
- The glymphatic-lymphatic axis: known pathways, open questions, and emerging roles in neurodegeneration.Translational neurodegeneration · 2026Review
- How brain pulsations drive solute transport in the cranial subarachnoid space: insights from a toy model.Journal of the Royal Society, Interface · 2026Article
- Multimodality imaging of cerebrospinal fluid shunts: system evaluation and complications.Pediatric radiology · 2026Review
- Nose-brain axis: A bridge from the nasal cavity to the central nervous system.Neural regeneration research · 2026Article
- Central nervous system lymphatic network: from the maintenance of brain homeostasis to emerging therapeutic perspectives in neurodegenerative diseases.Translational neurodegeneration · 2026Review
- In-silico solute transport via perivascular networks in the human intracranial space.Nature communications · 2026Article
- Brain barriers at the crossroads of glioma immune surveillance and immunotherapy response.Nature reviews. Cancer · 2026Review
- Lymphatic Drainage of Cerebrospinal Fluid Using Lymph Node Seeker 64Cu-Labeled Gram-Negative Bacterial Extracellular Vesicles With Positron Emission Tomography (PET).Journal of extracellular vesicles · 2026Article
- Article
- Glymphatic Dysfunction and Aquaporin-4 Dysregulation in Traumatic Brain Injury and Brain Tumors: A Review.Molecular neurobiology · 2026Review
- Serial failure of the brain clearance continuum in Alzheimer's disease: mechanisms and therapeutic perspectives.Journal of neurology · 2026Review
- The Clearance-Centered Bottleneck in Alzheimer's Disease: From Coupled Glymphatic-Lymphatic Circuits to Therapeutic Opportunities.Molecular neurobiology · 2026Review
- Article
- The Cribriform Plate: A Multifaceted Neuroimmune Hub in CNS Health and Disease.Medicina (Kaunas, Lithuania) · 2026Review
- Postmortem Evidence of Lymphatic Vessels Located at the Boundary of Central and Peripheral Nervous Systems in the Cervical Spine.Cellular and molecular neurobiology · 2026Article
- Artery-Like Smooth Muscle Drives Contractile Function in Dural Venous Sinuses.bioRxiv : the preprint server for biology · 2026Article
186 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author at 1 institution in 1 country.
Funding
Abstract
Cerebrospinal fluid (CSF) is produced by the choroid plexuses within the ventricles of the brain and circulates through the subarachnoid space of the skull and spinal column to provide buoyancy to and maintain fluid homeostasis of the brain and spinal cord. The question of how CSF drains from the subarachnoid space has long puzzled scientists and clinicians. For many decades, it was believed that arachnoid villi or granulations, outcroppings of arachnoid tissue that project into the dural venous sinuses, served as the major outflow route. However, this concept has been increasingly challenged in recent years, as physiological and imaging evidence from several species has accumulated showing that tracers injected into the CSF can instead be found within lymphatic vessels draining from the cranium and spine. With the recent high-profile rediscovery of meningeal lymphatic vessels located in the dura mater, another debate has emerged regarding the exact anatomical pathway(s) for CSF to reach the lymphatic system, with one side favoring direct efflux to the dural lymphatic vessels within the skull and spinal column and another side advocating for pathways along exiting cranial and spinal nerves. In this review, a summary of the historical and contemporary evidence for the different outflow pathways will be presented, allowing the reader to gain further perspective on the recent advances in the field. An improved understanding of this fundamental physiological process may lead to novel therapeutic approaches for a wide range of neurological conditions, including hydrocephalus, neurodegeneration and multiple sclerosis.
Indexed as
Identifiers
What OpenQuestion holds
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.