{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T18:26:32Z","timestamp":1772216792273,"version":"3.50.1"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T00:00:00Z","timestamp":1683158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>\n                    How cerebrospinal fluid (CSF) drains from the human brain is of paramount importance to cerebral health and physiology. Obstructed CSF drainage results in increased intra-cranial pressure and a predictable cascade of events including dilated cerebral ventricles and ultimately cell death. The current and accepted model of CSF drainage in humans suggests CSF drains from the subarachnoid space into the sagittal sinus vein. Here we identify a new structure in the sagittal sinus of the human brain by anatomic cadaver dissection.\n                    <jats:italic>The CSF canalicular system<\/jats:italic>\n                    is a series of channels on either side of the sagittal sinus vein that communicate with subarachnoid cerebrospinal fluid via Virchow-Robin spaces. Fluorescent injection confirms that these channels are patent and that flow occurs independent of the venous system. Fluoroscopy identified flow from the sagittal sinus to the cranial base. We verify our previous identification of CSF channels in the neck that travel from the cranial base to the subclavian vein. Together, this information suggests a novel path for CSF drainage of the human brain that may represent the primary route for CSF recirculation. These findings have implications for basic anatomy, surgery, and neuroscience, and highlight the continued importance of gross anatomy to medical research and discovery.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0285269","type":"journal-article","created":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T13:59:44Z","timestamp":1683208784000},"page":"e0285269","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Identification of a novel path for cerebrospinal fluid (CSF) drainage of the human brain"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3563-6610","authenticated-orcid":true,"given":"Joel E.","family":"Pessa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,5,4]]},"reference":[{"key":"pone.0285269.ref001","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1186\/s40001-022-00798-6","article-title":"Hydrocephalus: historical analysis and considerations for treatment","volume":"27","author":"A Hochstetler","year":"2022","journal-title":"Eur J Med Res"},{"key":"pone.0285269.ref002","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/107327481702400102","article-title":"Cerebrospinal Fluid and Hydrocephalus: Physiology, Diagnosis, and Treatment","volume":"24","author":"AK Filis","year":"2017","journal-title":"Cancer Control"},{"key":"pone.0285269.ref003","volume-title":"StatPearls","author":"T Huff","year":"2022"},{"key":"pone.0285269.ref004","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s12987-022-00323-1","article-title":"Cerebrospinal fluid production by the choroid plexus: a century of barrier research revisited","volume":"19","author":"N MacAulay","year":"2022","journal-title":"Fluids Barriers CNS"},{"issue":"6","key":"pone.0285269.ref005","first-page":"S93","article-title":"Is there a cerebral lymphatic system?","volume":"44","author":"JJ Iliff","year":"2013","journal-title":"Stroke"},{"key":"pone.0285269.ref006","doi-asserted-by":"crossref","first-page":"104987","DOI":"10.1016\/j.isci.2022.104987","article-title":"The glymphatic system: Current understanding and modeling","volume":"25","author":"T Bohr","year":"2022","journal-title":"iScience"},{"key":"pone.0285269.ref007","article-title":"Anatomy. A Regional Atlas of the Human Body. Baltimore-Munich: Urban and Schwarzenberg","author":"CD Clemente","year":"1987"},{"key":"pone.0285269.ref008","first-page":"e4597","article-title":"Superior Sagittal Sinus: A Review of the History, Surgical Considerations, and Pathology","volume":"11","author":"T Patchana","year":"2019","journal-title":"Cureus"},{"key":"pone.0285269.ref009","volume-title":"StatPearls","author":"V Letchuman","year":"2022"},{"key":"pone.0285269.ref010","doi-asserted-by":"crossref","first-page":"155","DOI":"10.3171\/JNS-07\/07\/0155","article-title":"Anatomy of the falcine venous plexus","volume":"107","author":"RS Tubbs","year":"2007","journal-title":"J Neurosurg"},{"key":"pone.0285269.ref011","volume-title":"Epistolaris de glandulis conglobatis durae meningis humani (Epistolary of the conglobatic glands of the human dural meninges)","author":"A. Pacchionus","year":"1705"},{"key":"pone.0285269.ref012","doi-asserted-by":"crossref","first-page":"698865","DOI":"10.3389\/fnagi.2021.698865","article-title":"No Arachnoid Granulations-No Problems: Number, Size, and Distribution of Arachnoid Granulations From Birth to 80 Years of Age","volume":"13","author":"M Rado\u0161","year":"2021","journal-title":"Front Aging Neurosci"},{"issue":"7560","key":"pone.0285269.ref013","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1038\/nature14432","article-title":"Structural and functional features of central nervous system lymphatic vessels","volume":"523","author":"A Louveau","year":"2015","journal-title":"Nature"},{"key":"pone.0285269.ref014","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s40478-020-0888-y","article-title":"Subdural haematomas drain into the extracranial lymphatic system through the meningeal lymphatic vessels","volume":"8","author":"X Liu","year":"2020","journal-title":"Acta Neuropathol Commun"},{"key":"pone.0285269.ref015","doi-asserted-by":"crossref","unstructured":"Pessa JE. Evidence suggests a novel cerebrospinal circulatory system exists in human nerves. MedRxiv doi: 10.1101\/2020.06.26.20141267","DOI":"10.1101\/2020.06.26.20141267"},{"key":"pone.0285269.ref016","volume-title":"Gray\u2019s Anatomy","author":"Henry Gray","year":"2013"},{"key":"pone.0285269.ref017","volume-title":"Sobotta Atlas of Human Anatomy","author":"Paulsen Friedrich","year":"2013"},{"key":"pone.0285269.ref018","volume-title":"Grant\u2019s Atlas of Anatomy","author":"AMR Agur","year":"2017"},{"key":"pone.0285269.ref019","doi-asserted-by":"crossref","first-page":"e4126","DOI":"10.1097\/GOX.0000000000004126","article-title":"Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves","volume":"17","author":"JE Pessa","year":"2022","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"pone.0285269.ref020","volume-title":"The anatomy of the adsorbing vessels of the human body","author":"WC Cruickshank","year":"1786"},{"key":"pone.0285269.ref021","volume-title":"Vasorum Lymphaticorum Corporis Human","author":"P. Mascagni","year":"1787"},{"key":"pone.0285269.ref022","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1093\/asj\/sjx089","article-title":"Periorbital and Temporal Anatomy, \"Targeted Fat Grafting,\" and How a Novel Circulatory System in Human Peripheral Nerves and Brain May Help Avoid Nerve Injury and Blindness During Routine Facial Augmentation","volume":"37","author":"JE Pessa","year":"2017","journal-title":"Aesthet Surg J"},{"key":"pone.0285269.ref023","volume-title":"StatPearls","author":"DH Garner","year":"2022"},{"key":"pone.0285269.ref024","volume-title":"Anatomie, Physiologie, Pathologie des vaisseaux lympatiques consideres chez l\u2019homme et les vertebre","author":"MPC Sappey","year":"1874"},{"key":"pone.0285269.ref025","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.neulet.2017.11.001","article-title":"Lymphatic vasculature in human dural superior sagittal sinus: Implications for neurodegenerative proteinopathies","volume":"665","author":"NP Visanji","year":"2018","journal-title":"Neurosci Lett"},{"key":"pone.0285269.ref026","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1038\/s41467-017-01484-6","article-title":"Outflow of cerebrospinal fluid is predominantly through lymphatic vessels and is reduced in aged mice","volume":"8","author":"Q Ma","year":"2017","journal-title":"Nat Commun"},{"key":"pone.0285269.ref027","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1038\/s41526-020-0097-9","article-title":"Spaceflight associated neuro-ocular syndrome (SANS) and the neuro-ophthalmologic effects of microgravity: a review and an update","volume":"6","author":"AG Lee","year":"2020","journal-title":"NPJ Microgravity"},{"key":"pone.0285269.ref028","doi-asserted-by":"crossref","first-page":"336","DOI":"10.18240\/ijo.2022.02.21","article-title":"Spaceflight-associated neuro-ocular syndrome: a review of potential pathogenesis and intervention","volume":"15","author":"JW Yang","year":"2022","journal-title":"Int J Ophthalmol"},{"key":"pone.0285269.ref029","doi-asserted-by":"crossref","first-page":"e2131465","DOI":"10.1001\/jamanetworkopen.2021.31465","article-title":"Comparison of Dural Venous Sinus Volumes Before and After Flight in Astronauts With and Without Spaceflight-Associated Neuro-Ocular Syndrome","volume":"4","author":"MJ Rosenberg","year":"2021","journal-title":"JAMA Netw Open"},{"key":"pone.0285269.ref030","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1038\/s41598-020-79695-z","article-title":"Effect of gravity on brain structure as indicated on upright computed tomography","volume":"11","author":"Y Yokoyama","year":"2021","journal-title":"Sci Rep"},{"key":"pone.0285269.ref031","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1113\/JP273557","article-title":"Effect of gravity and microgravity on intracranial pressure","volume":"595","author":"JS Lawley","year":"2017","journal-title":"J Physiol"},{"key":"pone.0285269.ref032","volume-title":"The Art of Aesthetic Surgery","author":"JE Pessa","year":"2020"},{"key":"pone.0285269.ref033","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1167\/iovs.61.14.34","article-title":"Decreased Vascular Patterning in the Retinas of Astronaut Crew Members as New Measure of Ocular Damage in Spaceflight-Associated Neuro-ocular Syndrome","volume":"61","author":"RJ Vyas","year":"2020","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0285269.ref034","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.3233\/JAD-220596","article-title":"Retinal Examinations Provides Early Warning of Alzheimer\u2019s Disease","volume":"90","author":"X Xia","year":"2022","journal-title":"J Alzheimers Dis"},{"key":"pone.0285269.ref035","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/S1474-4422(22)00173-9","article-title":"Imaging of the optic nerve: technological advances and future prospects","volume":"21","author":"V Biousse","year":"2022","journal-title":"Lancet Neurol"},{"key":"pone.0285269.ref036","first-page":"1878","article-title":"Prolonged Microgravity Affects Human Brain Structure and Function","volume":"40","author":"DR Roberts","year":"2019","journal-title":"AJNR Am J Neuroradiol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0285269","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T14:00:23Z","timestamp":1683208823000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0285269"}},"subtitle":[],"editor":[{"given":"Alvan","family":"Ukachukwu","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,5,4]]},"references-count":36,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0285269","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2023.01.13.23284147","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,4]]}}}