Reassessment of the pathways responsible for cerebrospinal fluid absorption in the neonate

Papaiconomou, Christina; Захаров, А. В.; Azizi, Navid; Djenic, J.; Johnston, Mary

doi:10.1007/s00381-003-0840-z

Cited by 66 publications

(56 citation statements)

References 29 publications

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“…Tracers injected directly into the CSF of rodents drain through channels in the cribriform plate into lymphatics of the nasal mucosa and from there to cervical lymph nodes (Cserr and Knopf, 1992;Kida et al, 1993;Knopf et al, 1995;Carare et al, 2008). In humans, CSF also drains through the cribriform plate to nasal lymphatics (Papaiconomou et al, 2004;Zakharov et al, 2004a). The bulk of the CSF, however, drains directly back into the blood through arachnoid granulations and villi, in the walls of intracranial and spinal venous sinuses (Weed, 1923;Weller, 1998).…”

Section: Introductionmentioning

confidence: 97%

Cervical lymph nodes are found in direct relationship with the internal carotid artery: Significance for the lymphatic drainage of the brain

et al. 2009

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The brain has no conventional lymphatics, but solutes injected into it drain along artery walls and reach lymph nodes in the neck. This study seeks to identify cervical lymph nodes related to the human internal carotid artery (ICA) that could act as the first regional lymph nodes for the brain. Bilateral dissections were carried out on four embalmed human heads, from the level of the carotid bifurcation in the neck, to the base of the skull. Lymph nodes from every specimen were processed for histological examination. A total of 51 deep cervical lymph nodes were identified: 12 lymph nodes (confirmed by histological examination) were observed to be in direct relationship with the ICA. These lymph nodes were found within the carotid sheath and had average diameters of 13.5 x 4.8 mm. Solutes and interstitial fluid from the brain may drain along the walls of cerebral arteries and reach these lymph nodes. They may be sites of stimulation of immune responses against antigens from the brain.

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Section: Introductionmentioning

confidence: 97%

Cervical lymph nodes are found in direct relationship with the internal carotid artery: Significance for the lymphatic drainage of the brain

et al. 2009

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“…The initial spike in blood tracer concentrations may have been due to direct transport of HSA into the cranial veins, as the intracranial pressure would be expected to increase temporarily due to the tracer injection into the ventricle. In past studies, we observed some transient direct CSF-cranial venous transport when intracranial pressure was elevated abruptly to high levels (36,46). However, the 10-min delay in the peak concentration of tracer in blood (40 min) compared with the turbinates (30 min) seems consistent with the view that a significant amount of the tracer made its way into blood after first traversing the lymphatic network in the olfactory turbinates, moving through the cervical lymphatics, and finally transporting into the venous system at the base of the neck.…”

Section: Discussionmentioning

confidence: 97%

“…tracer into the cranial venous system in sheep and observed that tracer entry into the superior sagittal sinus only occurred at high intracranial pressures (36,46). One possibility is that the arachnoid projections divert CSF from the cranium when intracranial pressure is transiently or chronically elevated.…”

Section: Discussionmentioning

confidence: 99%

“…It is generally assumed that CSF absorption occurs through the microscopic arachnoid villi and macroscopic granulations, which represent extensions of the arachnoid membrane into the lumen of cranial venous sinuses. However, there is relatively little convincing in vivo evidence to support this contention, and, consequently, this textbook view is increasingly being challenged (11,14,16,17,35,36,46). In contrast, there is abundant evidence to suggest that the lymphatic circulation plays an important role in volumetric CSF absorption.…”

Section: Discussionmentioning

confidence: 99%

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Quantification of cerebrospinal fluid transport across the cribriform plate into lymphatics in rats

Nagra¹,

Koh²,

Захаров³

et al. 2006

American Journal of Physiology-Regulatory, Integrative and Comp

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A major pathway by which cerebrospinal fluid (CSF) is removed from the cranium is transport through the cribriform plate in association with the olfactory nerves. CSF is then absorbed into lymphatics located in the submucosa of the olfactory epithelium (olfactory turbinates). In an attempt to provide a quantitative measure of this transport,125I-human serum albumin (HSA) was injected into the lateral ventricles of adult Fisher 344 rats. The animals were killed at 10, 20, 30, 40, and 60 min after injection, and tissue samples, including blood (from heart puncture), skeletal muscle, spleen, liver, kidney, and tail were excised for radioactive assessment. The remains were frozen. To sample the olfactory turbinates, angled coronal tissue sections anterior to the cribriform plate were prepared from the frozen heads. The average concentration of125I-HSA was higher in the middle olfactory turbinates than in any other tissue with peak concentrations achieved 30 min after injection. At this point, the recoveries of injected tracer (percent injected dose/g tissue) were 9.4% middle turbinates, 1.6% blood, 0.04% skeletal muscle, 0.2% spleen, 0.3% liver, 0.3% kidney, and 0.09% tail. The current belief that arachnoid projections are responsible for CSF drainage fails to explain some important issues related to the pathogenesis of CSF disorders. The rapid movement of the CSF tracer into the olfactory turbinates further supports a role for lymphatics in CSF absorption and provides the basis of a method to investigate the novel concept that diseases associated with the CSF system may involve impaired lymphatic CSF transport.

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“…Whereas originally it was assumed that the majority of CSF convected through the arachnoid villi and granulations into the cranial venous sinuses, the quantitative data suggests that the importance of this transport may have been exaggerated [12, 13]. Mounting evidence suggests that CSF drainage into extracranial lymphatic vessels cannot be ignored as studies in animal models indicate that a significant portion if not the majority of CSF transport can occur via this route [5, 6].…”

Section: Discussionmentioning

confidence: 99%

Properties of the Lymphatic Cerebrospinal Fluid Transport System in the Rat: Impact of Elevated Intracranial Pressure

Koh

Nagra²,

Johnston³

2007

J Vasc Res

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Previous studies suggested that a major portion of cerebrospinal fluid (CSF) is absorbed by extracranial lymphatics located in the olfactory turbinates. The objective of this study was to determine the impact of elevated intracranial pressure (ICP) on downstream cervical lymphatic pressures in the rat. Pressures were measured in the deep cervical lymph nodes using a servo-null micropressure system. A catheter was placed in a lateral ventricle and fluid was infused from a reservoir at defined ICPs. When Ringer’s solution was infused, elevations of ICP from 10 to 50 cm H₂O resulted on average in a reduction of diastolic cervical node pressures. In contrast, when a diluted plasma solution (80% plasma in Ringer’s) was infused, downstream diastolic lymphatic pressures increased as ICP was elevated to 50 cm H₂O. These data are consistent with the view that much of the CSF-derived water that convects into the lymphatics is absorbed into the ethmoidal or nodal blood vessels. This study supports the concept of fluid continuity between the subarachnoid space and extracranial lymphatics and suggests that this loss of CSF-derived water may act as a safety mechanism to reduce the volume load to the downstream lymphatic vessels.

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Reassessment of the pathways responsible for cerebrospinal fluid absorption in the neonate

Abstract: The data suggests that neonatal CSF can be absorbed directly into the cranial venous system. However, contrary to the classical view, this route may represent an auxiliary system that is recruited to compliment lymphatic transport when intracranial pressures are very high.

Cited by 66 publications

References 29 publications

Cervical lymph nodes are found in direct relationship with the internal carotid artery: Significance for the lymphatic drainage of the brain

Cervical lymph nodes are found in direct relationship with the internal carotid artery: Significance for the lymphatic drainage of the brain

Quantification of cerebrospinal fluid transport across the cribriform plate into lymphatics in rats

Properties of the Lymphatic Cerebrospinal Fluid Transport System in the Rat: Impact of Elevated Intracranial Pressure

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