Connections between the cerebrospinal fluid space and the lymphatic system of the head and neck in humans

Abstract

The lymphatic drainage of the cerebrospinal fluid (CSF) has been investigated in the 2nd half of the last centuiy by Schwalbe 1869, Key and Retzius in humans and animals in 1875. In 1872, Quincke hypothesized that a lymphatic connection between the subarachnoid space of the spinal marrow and the retroperitoneal space should exist suggested by black coloration of the retroperitoneal lymphatic vessels after injection of Indian ink in the cerebrospinal fluid. It was only in 1962, that the Hungarian internal physician and physiologist Foldi was successful in provoking lymphogenous encephalopathy, so called pseudo- tumor cerebri, by ligation or resection of the cervical lymphatics. In 1972, Arnold et al. were able to show that after injection of colorants, contrast substances, radioisotopes or cells of sarcoma into the cerebrospinal fluid of guinea pigs, a few minutes later these substances or cells were found either in the perilymph spaces of the cochlea or in the perineural spaces of several cranial nerves. Especially the olfactory fibres such as the lymphatics of the nasal mucosa represented the injected substances or cells but the highest concentration of the tracer was detectible in the deep lymph nodes of the neck. In 1979, Jackson and colleagues suggested that blockage of lymphatics due to inflammation of the nasal mucosa could lead to viral infection of the central nervous system. Bradbury et al. (1981) and Cserr et al. (1992) proved that using radiolabeled albumin in rabbits, cats and sheep, that the percentage of lymph drainage from the brain ranges between 14% to 50%. In 1992, Weller et al. and in 1994, Lowhagen et al. investigated the lymphatic drainage from the brain in humans. As up to now the definite proof of a direct connection between the cerebrospinal space and head and neck lymph system in humans is still lacking.