Glymphatics for the Neurosurgeon

The glymphatic system is a recently described open vascular system within the brain that allows cerebrospinal fluid to flow into brain parenchyma through perivascular spaces and clears interstitial solutes into the traditional closed vascular system. Although it was initially difficult to study, new evidence suggests that the glymphatic system plays a pivotal role in the pathophysiology of multiple diseases of the central nervous system including traumatic brain injury, hydrocephalus, dementia, and malignancy. In this review, we cover the basics of cerebrospinal fluid dynamics and explore the role of the glymphatic system in traumatic brain injury, post subarachnoid hemorrhage hydrocephalus, normal pressure hydrocephalus, and malignancy. We believe that further understanding of the glymphatic system will lead to new and better therapeutic options for these diseases moving forward.