Neck surgery raises hope for Alzheimer's patients: What to know

Editor's note: Alzheimer's disease and other dementias afflict nearly 17 million people in China, destroying neurons irreversibly. Existing drugs – costly and effective only in early stages – offer limited relief. Now, an experimental neck surgery, repurposed to boost the brain's toxin-clearing "plumbing," has sparked cautious optimism. Though not yet validated by large-scale trials and carrying surgical risks, its allure is undeniable for families of advanced patients. CGTN spoke to Dr Xie Qingping, a surgeon pioneering the research, to find out more about it.

In a bold attempt to tackle one of medicine's most intractable diseases, Chinese hospitals are exploring deep cervical lymphovenous anastomosis (dcLVA), a neck surgery repurposed from lymphatic edema treatment, as a potential intervention for Alzheimer's disease (AD).

Spearheading this experimental approach is Dr. Xie Qingping, a surgeon specialized in microsurgery and lymphatic surgery. Also the president of Hangzhou Qiushi Hospital, Xie claims over 600 patients have undergone the procedure since 2020, with 80 percent showing cognitive or behavioral improvements.

The discovery

Originally developed for limb lymphedema, LVA involves rerouting blocked lymphatic vessels to veins. In 2019, while operating on a patient with chronic tinnitus and headaches, Xie noticed abnormal cervical lymphatic structures. Based on decades of experience, he connected these blocked lymphatic vessels and lymph nodes to neck veins, a combined approach of LVA and LNVA (lymph nodes to vein anastomosis), to ease the blockage. 

In addition to vanished tinnitus, the patient reported unexpected neurological benefits after the treatment: clearer vision and reduced brain fog.

"This hinted at a link between cervical lymphatic drainage and central nervous system detoxification," said Xie.

He later connected his observations to brain research by U.S. neuroscientists Jonathan Kipnis, Antoine Louveau and their colleagues in recent years. Their work revealed the brain's overlooked drainage systems- the glymphatic system and meningeal lymphatics- which flush toxic proteins like amyloid-beta and tau, hallmarks of AD.

Early results

Since 2020, after animal experiments, mechanism research, and ethical reviews, Xie's team has performed dcLVA on over 600 patients, primarily those with moderate-to-severe AD, alongside exploratory cases of other neurological disorders like Parkinson's disease, amyotrophic lateral sclerosis (ALS), and multiple system atrophy (MSA).

Participants, all unresponsive to conventional therapies, were rigorously screened for surgical fitness and informed consent.  

According to Xie, three-to-six-month follow-ups showed 80 percent experienced cognitive score increases, better sleep, and mood stabilization. Preliminary imaging suggested reduced metabolic waste buildup in the brain.

"We think it indicates potential mechanism-related changes associated with dcLVA. Relevant data is currently being prepared for publication," Xie added.

Global interest

The approach has drawn both domestic and international attention, with Singapore's Changi General Hospital planning its first dcLVA surgery in April, while U.S., European, and other Asian institutions pursue ethical approvals.

"I believe that in the next one to two years, we will witness the gradual expansion of dcLVA surgery worldwide," said Xie.

This week, along with several Chinese surgeons, Xie has shared recent observations and findings of this treatment approach at the 13th Congress of World Society for Reconstructive Microsurgery held in Spain.

LVA usually involves anastomosing lymphatic vessels to veins with a diameter of just 0.3-0.8 mm, a procedure that demands highly skilled techniques and the use of a high-power microscope. Thanks to the progress in microsurgical technology, it is now possible to attempt anastomosis of lymphatic vessels as fine as 0.2 mm in diameter, but this is extremely challenging. Up to now, fewer than 30 hospitals have registered for the clinical trial of dcLVA on the official website of the Chinese Clinical Trial Registry.

Scientific skepticism

Yet critics highlight unresolved questions: AD's exact etiology remains murky, and dcLVA's mechanism – dubbed "decompressive detox" by Xie –  lacks robust evidence.

Some doctors in China conducting clinical trials have noted that the surgery's effectiveness is not as high as Xie claims. Fluctuations also happen in some patients' post-operation cognition.

"We welcome scrutiny," said Xie, emphasizing dcLVA's exploratory status. "This is a new pathway for a field starved of breakthroughs."

Collaborating with Beijing Tiantan hospital's team led by neurology scientist Wang Yilong, Xie and his team launched a new clinical trial in February 2025. Named CLEAN-AD, the randomized controlled trial (RCT) will standardize surgical protocols, incorporate multidisciplinary assessments, and invite international observers to ensure transparency.  

"Neurosurgeons' involvement will refine technical precision and broaden evaluation metrics," Xie noted, adding that the study aims to establish efficacy rates and safety profiles while addressing current inconsistencies in surgical outcomes.  

"This RCT study will be the most extensive and rigorous scientific research on the surgical treatment of AD in the world so far," said Xie.