Yann Decker,1 Jonas Krämer,1 Li Xin,2 Andreas Müller,3 Anja Scheller,4 Klaus Fassbender,1 and Steven T. Proulxcorresponding author2


"1Department of Neurology, Saarland University Medical Center, Homburg, Germany.
2Theodor Kocher Institute, University of Bern, Bern, Switzerland.
3Clinic for Diagnostic and Interventional Radiology and
4Molecular Physiology, Center for Integrative Physiology and Molecular Medicine, University of Saarland, Homburg, Germany.
corresponding authorCorresponding author.
Yann Decker: [email protected]; Jonas Krämer: [email protected]; Andreas Müller: [email protected]; Anja Scheller: [email protected]; Klaus Fassbender: [email protected]; Steven T. Proulx: [email protected]
Address correspondence to: Yann Decker, Department of Neurology, Saarland University Medical Center, 66421 Homburg/Saar, Germany. Phone: 49.6841.1624215; Email: [email protected] Or to: Steven T. Proulx, Theodor Kocher Institute, University of Bern, CH‑3012 Bern, Switzerland. Phone: 41.31.631.5390; Email: [email protected]"


Medical Research, Neuroscience


"The anatomical routes for the clearance of cerebrospinal fluid (CSF) remain incompletely understood. However, recent evidence has given strong support for routes leading to lymphatic vessels. A current debate centers upon the routes through which CSF can access lymphatics, with evidence emerging for either direct routes to meningeal lymphatics or along cranial nerves to reach lymphatics outside the skull. Here, a method was established to infuse contrast agent into the ventricles using indwelling cannulae during imaging of mice at 2 and 12 months of age by magnetic resonance imaging. As expected, a substantial decline in overall CSF turnover was found with aging. Quantifications demonstrated that the bulk of the contrast agent flowed from the ventricles to the subarachnoid space in the basal cisterns. Comparatively little contrast agent signal was found at the dorsal aspect of the skull. The imaging dynamics from the 2 cohorts revealed that the contrast agent was cleared from the cranium through the cribriform plate to the nasopharyngeal lymphatics. On decalcified sections, we confirmed that fluorescently labeled ovalbumin drained through the cribriform plate and could be found within lymphatics surrounding the nasopharynx. In conclusion, routes leading to nasopharyngeal lymphatics appear to be a major efflux pathway for cranial CSF.

Keywords: Neuroscience, Vascular Biology
Keywords: Lymph, Neuroimaging



Imaging of the nasal region was done under a Zeiss Axio Zoom.V16 microscope equipped with a Teledyne Photometrics Prime BSI Scientific CMOS camera combined with a CoolLED pE-4000 illumination system and ZEN 2 software (Zeiss).

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The pE-4000 Universal Illumination System offers 16 selectable wavelengths from 365 - 770 nm, making it a highly flexible illuminator covering a wide variety of fluorophores

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JCI insight

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