Preliminary clinical efficacy observation of lymphatic/lymph node-venous shunt surgery in cervical region Ⅱ/Ⅲ for the treatment of Alzheimer’s disease LI Ke1
， WEN Ke1
， AI Songtao2
， YAN Jia3
， WANG Haiya4
， LI Zan5
， LI Bin6
， MIN Peiru1
， MENG Xinxian1
， WANG Xueqian1
， HAN Chengyao1
， SUN Yuhao1
， LIU Jiaqi7
， WU Jingshu1
， WEI Yanxue1
， SONG Xingqi1
， ZHANG Yixin1
. 1 Department of Plastic and Reconstructive Surgery， Shanghai Ninth People’s Hospital， Shanghai
Jiao Tong University School of Medicine， Shanghai 200011， China；2 Department of Radiology， Shanghai Ninth People’s
Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200011， China；3 Department of Anesthesiology， Shanghai Ninth People’s Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200011， China；4 Department of Geriatrics， Shanghai Ninth People’s Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200011， China；5 Department of Oncoplastic Surgery， Hunan Cancer Hospital， Changsha 410008， China；6 Department of OtorhinolaryngologyHead and Neck Surgery， Sichuan Provincial People's Hospital， Sichuan Academy of Medical Sciences， Chengdu 610041， China；7 Department of Burn and Plastic Surgery， Shanghai Ruijin Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200025， China. Corresponding author： ZHANG Yixin （E-mail： zhangyixin6688@163.com）.
therapeutic principles and efficacy of this method in treating Alzheimer’s disease （AD）. Methods Patients underwent the
lymphatic/lymph node-venous shunt surgery in the cervical Ⅱ/Ⅲ region. Cognitive assessments， including the MMSE，MoCA， and NPI， were conducted before and one month after surgery to evaluate symptom improvement. PET-CT was used to
quantitatively analyze changes in intracranial Aβ protein levels. Color Doppler ultrasound was employed to measure the patency of the internal jugular vein and detect wall-adherent thrombus formation. Postoperative follow-up within one month included monitoring wound healing， hematoma or fluid accumulation， lymphatic leakage， postoperative delirium，headaches， and other discomforts. Results This study included 7 AD patients （3 males and 4 females） with an average age of 65（57-71） years. All patients had AD with dementia. Compared to preoperative scores， one month postoperatively， MMSE improved by 0（-2，1） points （P=0.581）， MoCA improved by 0（-1，1） points （P=1.000）， NPI （frequency× severity） improved by 9（9，20） points （P=0.043）， and NPI caregiver distress improved by 2（2，6） points （P=0.026）. Color Doppler ultrasound indicated patent internal jugular venous flow without wall-adherent thrombus. No adverse reactions were observed. Three patients underwent PET-CT one month postoperatively， showing an average reduction of 12.3% in whole-brain Aβ protein levels. Conclusion The proposed lymphatic/lymph node-venous shunt surgery in the cervical Ⅱ/Ⅲ region can divert the extracranial segment of intracranial lymphatic drainage， promote the clearance of pathological proteins， reduce intracranial Aβ protein levels， and improve clinical symptoms. This procedure may become a viable treatment option for AD， advancing the development of surgical interventions for AD.
