The glymphatic system, a brain-wide pathway for cerebrospinal fluid (CSF) circulation and waste clearance, has been increasingly recognized in neurosurgical contexts. This scoping review summarizes current literature on the glymphatic system's role in neurosurgical conditions and its potential as a therapeutic target. Studies from 2012 to 2023, including both human and animal research, highlight dysregulation of the glymphatic system in conditions such as idiopathic normal pressure hydrocephalus (iNPH), idiopathic intracranial hypertension (IIH), subarachnoid hemorrhage (SAH), stroke, intracranial tumors, and traumatic brain injury (TBI). Impaired glymphatic function is associated with delayed CSF clearance, altered brain edema, and neurological deficits. The regulation of aquaporin-4 (AQP4) channels is a key therapeutic target, as AQP4 plays a central role in glymphatic function. Therapeutic interventions such as nimodipine and tissue plasminogen activator (tPA) have shown promise in improving glymphatic function and outcomes in SAH. In stroke, glymphatic dysfunction correlates with edema and recovery. In TBI, AQP4 knockout studies suggest potential neuroprotective effects. The glymphatic system's involvement in brain tumors is also noted, with impaired function linked to tumor progression and peritumoral edema. The review emphasizes the need for further human studies to translate these findings into clinical practice, with a focus on non-invasive biomarkers and long-term effects of glymphatic dysfunction. The glymphatic system's role in neurosurgical pathophysiology underscores its importance in brain edema and CSF dynamics, offering new therapeutic strategies targeting AQP4 channels.The glymphatic system, a brain-wide pathway for cerebrospinal fluid (CSF) circulation and waste clearance, has been increasingly recognized in neurosurgical contexts. This scoping review summarizes current literature on the glymphatic system's role in neurosurgical conditions and its potential as a therapeutic target. Studies from 2012 to 2023, including both human and animal research, highlight dysregulation of the glymphatic system in conditions such as idiopathic normal pressure hydrocephalus (iNPH), idiopathic intracranial hypertension (IIH), subarachnoid hemorrhage (SAH), stroke, intracranial tumors, and traumatic brain injury (TBI). Impaired glymphatic function is associated with delayed CSF clearance, altered brain edema, and neurological deficits. The regulation of aquaporin-4 (AQP4) channels is a key therapeutic target, as AQP4 plays a central role in glymphatic function. Therapeutic interventions such as nimodipine and tissue plasminogen activator (tPA) have shown promise in improving glymphatic function and outcomes in SAH. In stroke, glymphatic dysfunction correlates with edema and recovery. In TBI, AQP4 knockout studies suggest potential neuroprotective effects. The glymphatic system's involvement in brain tumors is also noted, with impaired function linked to tumor progression and peritumoral edema. The review emphasizes the need for further human studies to translate these findings into clinical practice, with a focus on non-invasive biomarkers and long-term effects of glymphatic dysfunction. The glymphatic system's role in neurosurgical pathophysiology underscores its importance in brain edema and CSF dynamics, offering new therapeutic strategies targeting AQP4 channels.