Promising outcomes 5 weeks after a surgical cervical shunting procedure to unclog cerebral lymphatic systems in a patient with Alzheimer’s disease

Recently, the glymphatic system has been recognised as an important ‘waste solutes transport channel’ within the brain.1 Studies have shown that blockage of the glymphatic system leads to increased beta-amyloid deposits, accelerating the onset and progression of Alzheimer’s disease (AD).1 2 Given that cervical lymph nodes receive cerebrospinal fluid from the brain’s glymphatic system,3 4 we speculated that decompression of the lymphatic trunk and cervical lymphatic–venous anastomosis (LVA) could facilitate the flow of cerebrospinal fluid in the cranial glymphatic system, potentially accelerating the clearance of harmful beta-amyloid and tau proteins. We collaborated with surgeons who specialise in LVA supermicrosurgery for maxillofacial tumours and lymphoedema to develop a procedure to relieve the blockage of the glymphatic system. This surgery employs supermicrosurgery techniques to create LVA connecting the bilateral cervical, deep lymphatic vessels to the veins, resulting in lymphatic trunk decompression, which allows the lymph fluid in the high-pressure lymphatic vessels to flow into the low-pressure venous system. The goal of the minimally invasive surgery is to enhance the removal of proteins, such as beta-amyloid and tau, from the brain’s lymphatic systems to the maxillofacial lymphatic vessels, unclogging protein blockages within the brain. This extracranial procedure is safer than intracranial approaches. Following a thorough assessment of the safety and potential efficacy of the procedure, and securing ethics approval from the Ethics Committees of the Shanghai Mental Health Center and Shanghai Ninth People’s Hospital, we initiated an investigator-initiated trial of the ‘Cervical Shunting to Unclog cerebral Lymphatic …