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Publications

Journal Article Review Ahead of print

PubMed: 42087166 DOI: 10.1186/s13054-026-06063-0

microGLYMPH: a conceptual translational roadmap for microdialysis‑based assessment of CSF-interstitial solute exchange in acquired brain injury.

Crit Care

Authors: Nagesh C Shanbhag, Chisomo Zimphango, Nils Hecht, Bryn A Martin, Christos Panotopoulos, Elisa Gouvea Bogossian, Fabio S Taccone, Andres M Rubiano, Peter J Hutchinson, Niklas Marklund, Jefferson W Chen, Peter Vajkoczy

Affiliations

  • Meditech Foundation, Valle del Cauca, Cali, 760031, Colombia.
  • Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK.
  • Department of Neurosurgery, Charite Universitatsmedizin, Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, 10117, Germany.
  • Department of Chemical and Biological Engineering, University of Idaho, Moscow, 83843, ID, USA.
  • Flux Neuroscience, LLC, Troy, ID, USA.
  • Department of Neurosurgery, Mediterraneo Hospital, Glyfada, 16675, Greece.
  • Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Universite Libre de Bruxelles (ULB), Brussels, 1050, Belgium.
  • Meditech Foundation, Valle del Cauca, Cali, 760031, Colombia.
  • Neuroscience Institute, Neurotrauma Group, El Bosque University, Bogotá, 110121, Colombia.
  • Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skane University Hospital, Lund, 22185, Sweden.
  • Department of Neurosurgical Surgery, University of California, Irvine Medical Center, Orange, 92868, CA, USA.
  • Department of Neurosurgery, Charite Universitatsmedizin, Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, 10117, Germany.

Abstract

The glymphatic system facilitates cerebrospinal fluid (CSF)-interstitial fluid exchange and plays a key role in solute clearance and neurophysiological homeostasis. While dysfunction of this system has been shown in traumatic brain injury, stroke, meningitis, idiopathic normal pressure hydrocephalus and neurodegenerative diseases, direct measurement of glymphatic transport in humans remains elusive. We propose microGLYMPH as a translational, hypothesis-generating framework that combines established clinical cerebral microdialysis with controlled CSF tracer administration via existing clinical access routes, including an external ventricular drain, cisternal access during surgery, or lumbar intrathecal injection when clinically justified. The aim is to obtain time-resolved regional tracer profiles in microdialysate and to interpret these alongside arousal state, intracranial dynamics, and, where available, complementary imaging, thereby providing an indirect measure of CSF-interstitial exchange kinetics and peripheral tracer appearance. We further define the key design, analytical and practical limitations that must be resolved before the approach can extend beyond exploratory use, notably catheter-adjacent effects, blood-brain barrier disruption, drainage practices, and the intrinsically focal nature of microdialysis. microGLYMPH is therefore intended as a staged roadmap for first-in-human feasibility studies and subsequent hypothesis-driven investigations of neurofluid solute transport after acute brain injury.

MeSH

Brain Injuries, Brain