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Reply to: Rethink the classical view of cerebrospinal fluid production

Nature Reviews Neurology volume 17, pages 590–591 (2021)Cite this article

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We thank Roques and colleagues for their comments on our Review (Wardlaw, J. M. et al. Perivascular spaces in the brain: anatomy, physiology, and pathology. Nat. Rev. Neurol. 16, 137–153 (2020)1), in which they correctly point out some textbook dogma that needs to be re-evaluated (Roques, M., De Barros, A. & Bonneville, F. Rethink the classical view of cerebrospinal fluid production. Nat. Rev. Neurol. https://doi.org/10.1038/s41582-021-00538-0 (2021)2). We agree that the questions of how much cerebrospinal fluid (CSF) is produced and from which structures remain unanswered. In our Review, we noted that there are several potential sources of CSF, including the choroid plexus, but information about the relative contributions of each source is unfortunately limited.

In our Review1, we focused on perivascular spaces as seen in vivo on human brain imaging, how these relate to perivascular spaces as described histologically, and their role in brain fluid management. Perivascular spaces themselves have been a controversial topic since the 1800s, and clarification of their role, along with a full understanding of brain fluid management, would be of great value.

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Acknowledgements

The authors acknowledge the Fondation Leducq Transatlantic Network of Excellence for the Study of Perivascular Spaces in Small Vessel Disease (grant reference 16 CVD 05).

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Authors and Affiliations

  1. Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK

    Joanna M. Wardlaw

  2. Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA

    Helene Benveniste

  3. Section for Translational Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Maiken Nedergaard

  4. Division of Glia Disease and Therapeutics, Center for Translational Neuromedicine, University of Rochester Medical School, Rochester, NY, USA

    Maiken Nedergaard

  5. Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Berislav V. Zlokovic

  6. Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Berislav V. Zlokovic

  7. INSERM, CNRS, Institute de la Vision, Paris, France

    Serge Charpak

  8. Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK

    Kenneth J. Smith

  9. Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Sandra E. Black

  10. Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada

    Sandra E. Black

Authors
  1. Joanna M. Wardlaw
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  2. Helene Benveniste
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Correspondence to Joanna M. Wardlaw.

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Wardlaw, J.M., Benveniste, H., Nedergaard, M. et al. Reply to: Rethink the classical view of cerebrospinal fluid production. Nat Rev Neurol 17, 590–591 (2021). https://doi.org/10.1038/s41582-021-00539-z

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