The Pathogenesis Based on the Glymphatic System, Diagnosis, and Treatment of Idiopathic Normal Pressure Hydrocephalus

Abstract

Changwu Tan,1– 3,* Xiaoqiang Wang,4,* Yuchang Wang,1– 3 Chuansen Wang,1– 3 Zhi Tang,5 Zhiping Zhang,1– 3 Jingping Liu,1– 3 Gelei Xiao1– 3 1Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People’s Republic of China; 2Diagnosis and Treatment Center for Hydrocephalus, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People’s Republic of China; 3National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People’s Republic of China; 4Pediatric Neurological Disease Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, People’s Republic of China; 5Department of Neurosurgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, People’s Republic of China*These authors contributed equally to this workCorrespondence: Gelei XiaoDepartment of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People’s Republic of ChinaTel [phone]Email [email protected]: Idiopathic normal pressure hydrocephalus (iNPH) is a rare neurological disorder with no clear prevalence factors and is a significant danger to the elderly. The intracranial glymphatic system is the internal environment that maintains brain survival and metabolism, and thus fluid exchange changes in the glymphatic system under various pathological conditions can provide important insights into the pathogenesis and differential diagnosis of many neurodegenerative diseases such as iNPH. iNPH can be diagnosed using a combination of clinical symptoms, imaging findings and history, and cerebrospinal fluid biomarkers due to the glymphatic system disorder. However, only few researchers have linked the two. Shunt surgery can improve the glymphatic system disorders in iNPH patients, and the surgical approach is determined using a combination of clinical diagnosis and trials. Therefore, we have composed this review to provide a future opportunity for elucidating the pathogenesis of iNPH based on the glymphatic system, and link the glymphatic system to the diagnosis and treatment of iNPH. The review will provide new insights into the medical research of iNPH.Keywords: idiopathic normal pressure hydrocephalus, glymphatic system, pathogenesis, diagnostic methods, shunt surgery

Keywords

• idiopathic normal pressure hydrocephalus
• glymphatic system
• pathogenesis
• diagnostic methods
• shunt surgery.