Six Month Study of Therapeutic Effects of Deep Cervical Lymphaticovenular Anastomosis in an Alzheimer's Disease Patient: A Case Report

1.1. Introduction and Importance Degeneration of the central lymphatic system is reported to account for pathogenesis of aging-associated Alzheimer's disease (AD) through accumulation of metabolic waste of large molecules in the mouse brain. The findings remain to be translated into a clinic therapy of AD. 1.2. Methods Fluorescence dye of indocyanine green was used to identify blockage of deep cervical lymphatic system in an AD patient. Lymphaticovenular anastomosis (LVA), a super- microsurgical technique, was conducted to connect the influx lymphatics of obstructed lymph nodes into the jugular vein to fix the blockage. 1.3. Outcomes Obstruction was found in lymph nodes of the district 3 (area III) of deep cervical area on both sides of the AD patients. The surgery resolved the obstruction and improved behaviour, memory and psychiatry of the AD patient. The improvement was confirmed in the follow-up studies at 1st, 4th and 6th months. p-tau181 level was decreased in the peripheral blood from 4.26 pg/ml before surgery to 0.64 pg/ml at 6th month post surgery. The PET-CT image of glucose utilization demonstrated that the neuronal functions were increased in multiple areas of the brain. 1.4. Conclusion: The deep cervical lymphatic system was dysfunctional in the AD patient due to obstruction of lymph nodes in the district 3. The LVA surgery fixed the obstruction and generated a consistent therapeutic effect independent of anaesthetics in the patient for months.