Can supermicrosurgery treat Alzheimer's disease? - Current evidence and hope.

Alzheimer’s disease is characterized by a loss of temporal and spatial orientation and a progressive loss of cognitive and locomotor function. Therapeutic drug options are currently limited. There is evidence that degradation products of Alzheimer’s diseases such as the tau protein or amyloid beta in Alzheimer’s disease could be removed by the glymphatic system (lymphatic system of the brain), as these drain into the deep cervical lymph nodes. The microsurgical creation of lympho-venous anastomoses could improve this drainage and improve cognition in Alzheimer’s patients (probably also for other neurodegenerative disorders). To date, however, only a few case studies and small cohort studies have been published. Despite the compelling theoretical rationale, there is currently insufficient evidence to support a therapeutic recommendation. The long-term consequences remain unknown, and a structured, stepwise program of follow-up studies is required to further investigate the proposed association. This narrative review aims to provide an overview of the opportunities as well as critical considerations in this complex field. As head and neck surgeons, we are experienced in head and neck surgery and the armamentarium of our speciality field can be widen by these procedures in the future.