A Novel Microsurgical Model of Cervical Lymph Node-to-Vein Anastomosis (LNVA) for Studying Brain Lymphatic Outflow

Background: Cervical lymphaticovenous bypass has recently emerged as an innovative surgical approach to enhance brain lymphatic clearance for the treatment of Alzheimer disease (AD). Although early clinical findings are promising, the absence of a reproducible preclinical model has hindered mechanistic investigations and translational advancements. Objective: This study aimed to establish the first rat model for cervical LVA, addressing technical challenges and providing a standardized platform for preclinical research on lymphatic clearance and its role in neurodegeneration. Methods: Rats underwent bilateral cervical LNVA using high-magnification supermicrosurgical techniques. After identification of the deep cervical lymph nodes, end-to-side lymph node-to-venous anastomosis was performed. Anastomotic patency was confirmed intraoperatively by direct visualization without leakage. Indocyanine green (ICG) lymphangiography, performed through nasal administration, demonstrated fluorescence drainage into the external jugular vein. Results: With progressive refinement of microsurgical skills and improved anatomic familiarity, procedural stability was achieved. In the final cohort of 5 rats, all LVA procedures resulted in successful anastomotic patency. Conclusion: This study is the first to establish a rat model of cervical deep lymph node–venous anastomosis (LNVA), offering a novel microsurgical platform with dual value. On one hand, it serves as a technically demanding and reproducible model for advanced training in plastic and lymphatic surgery. On the other, it provides a structurally precise, gain-of-function approach for targeted intervention of the deep cervical lymph nodes—an anatomic hub increasingly implicated in brain lymphatic clearance and neurodegeneration. As such, this model may contribute meaningfully to future mechanistic studies on glymphatic function and its modulation.