5. CSF outflow along spinal nerves – A neuroradiological documentation

Abstract

Quincke in 1872 demonstrated that CSF is flowing out from the subarachnoid spaces along spinal nerves into peripheral tissues. CSF outflow through the cribriform plate near olfactory nerves was extensively demonstrated whereas poorly investigated along brain nerves and rarely along spinal nerves. From clinical observations it was hypothesized, that CSF may interact at the peripheral CSF outflow pathway (PCOP) with nerves and at wind up in peripheral tissues [1]. We further demonstrated that leukaemia cells followed the PCOP into periphery including subcutaneous tissues [2]. PCOP associated pathogenetic mechanisms, not been proven yet, have the potential to better understand pathogenetic aspects in neuroinflammatory disorders including subgroups of severe psychiatric disorders, associated with low level neuroinflammation, e.g. schizophrenia, or in fibromyalgia. Here, we demonstrate in a human subject supposed to lumbar myelography, CSF flowing from the subarachnoid spaces down the lumbar nerves, making a distance of 50.8 mm in 30 min. This supports the PCOP hypothesis which requires however much more research on anatomical details and the variety of pathogenetic questions raised.