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Trauma Research Program and Department of Pathology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada M4N 3M5; and Department of Medicine, University of Rochester, Rochester, New York 14642
We estimated the volumetric clearance of cerebrospinal fluid (CSF) through arachnoid villi and extracranial lymphatics in conscious sheep. Catheters were inserted into both lateral ventricles, the cisterna magna, multiple cervical lymphatics, thoracic duct, and jugular vein. Uncannulated cervical vessels were ligated. 125I-labeled human serum albumin (HSA) was administered into both lateral ventricles. 131I-HSA was injected intravenously to permit calculation of plasma tracer loss and tracer recirculation into lymphatics. From mass balance equations, total volumetric absorption of CSF averaged 3.37 ± 0.38 ml/h, with 2.03 ± 0.29 ml/h (~60%) removed by arachnoid villi and 1.35 ± 0.46 ml/h (~40%) cleared by lymphatics. With projected estimates for noncannulated ducts, total CSF absorption increased to 3.89 ± 0.33 ml/h, with 1.86 ± 0.49 ml/h (48%) absorbed by lymphatics. Additionally, we calculated total CSF drainage to be 3.48 ± 0.52 ml/h, with 54 and 46% removed by arachnoid villi and lymphatics, respectively, using previously published mass transport data from our group. We employed estimates of CSF tracer concentrations that were extrapolated from relationships observed in the study reported here. We conclude that 40-48% of the total volume of CSF absorbed from the cranial compartment is removed by extracranial lymphatic vessels.
cerebrospinal fluid drainage; arachnoid villi; brain; spinal cord; lymph nodes; lymphatic vessels
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