A video showing an 80-year-old man recovering after experimental Alzheimer’s surgery has sparked global interest in a procedure called deep cervical lymphatic-venous anastomosis, or dcLVA.
At the beginning of the footage, the man lies slumped in a hospital bed, his face hollow and his eyes tightly closed. Three days later, he is alert and able to identify his son. Six months after surgery, he sits upright and carries on a conversation. By eight months, he walks briskly down a hospital corridor while reciting a nearly century-old Maoist military anthem from memory.
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The footage documents the recovery of a man who, in September 2020, became the first person to undergo dcLVA as a treatment for Alzheimer’s disease. The experimental surgery connects tiny lymphatic vessels in the neck to nearby veins. These vessels form part of the body’s drainage network, which carries waste away from the brain. By creating a new connection, surgeons hope to improve the movement of fluid and waste proteins into the bloodstream.
The treatment was first described1 in 2022 in a Chinese-language medical journal by microsurgeon Qingping Xie, president of Qiushi Hospital in Hangzhou, China. The report initially attracted little attention. That changed the following year, when Wei Chen, a lymphatic microsurgeon at Cleveland Clinic in Ohio, began presenting the footage—with permission from Xie and the patient’s family—at surgical conferences worldwide.
“A lot of jaws dropped,” recalls Chen. “It basically started a frenzy of this surgery being performed left and right.”
Almost all of the procedures were carried out in China, where hundreds of hospitals soon began offering the experimental Alzheimer’s treatment. Viral testimonials and aggressive marketing on social-media platforms such as Douyin and WeChat helped attract thousands of patients. Many reportedly paid more than 200,000 yuan (US$30,000) in the hope of reversing or slowing dementia.
The rapid growth of dcLVA, despite limited clinical evidence, eventually prompted Chinese regulators to intervene. Last year, officials restricted the procedure to more formal clinical research settings rather than the loosely regulated use that had spread across the country. Xie, the pioneer of the technique, has been in detention since September for undisclosed reasons.
The great brain clearance and dementia debate
As controlled clinical studies begin in several countries, researchers remain divided over whether dcLVA can change the course of Alzheimer’s disease. The biological explanation for the surgery is plausible, but it does not fully explain how some patients appear to improve so quickly. Doctors also warn of potential complications, including infection, bleeding and damage to nearby nerves.
Nature spoke with more than two dozen researchers, revealing both cautious optimism and deep scepticism about the experimental surgery.
“The concept is scientifically valid and biologically plausible,” says Young-Kwon Hong, a lymphatics researcher at Beth Israel Deaconess Medical Center in Boston, Massachusetts. But he cautions that public enthusiasm has moved faster than the evidence. “The hope is high,” he says, “and whenever hope is high, the hype also follows.”
How dcLVA became an experimental Alzheimer’s treatment
Xie did not originally intend to develop a new Alzheimer’s therapy. Trained as a reconstructive microsurgeon, he specialises in reconnecting damaged blood vessels rather than studying the brain’s drainage system. However, interviews he gave before his detention—and accounts from his daughter, Angela, who spoke with Nature—suggest that a case of tinnitus redirected his research.
In 2019, while operating on a middle-aged woman to relieve pressure on nerves involved in hearing, Xie noticed unusual lymphatic structures deep in her neck. To bypass the abnormal area, he connected lymphatic vessels to nearby veins. The technique had originally been developed in the 1960s to treat lymphoedema, a painful swelling that can occur when cancer treatment damages or removes lymph nodes.
After surgery, the woman reported that her tinnitus had improved. She also said that her mental sharpness had increased. Xie investigated further and found research that appeared to offer a possible explanation.
In 2015, a team led by neuroimmunologist Jonathan Kipnis identified lymphatic vessels in the protective membranes surrounding the brain. The discovery overturned the long-standing belief that the brain lacked a conventional lymphatic system2. Three years later, Kipnis and his colleagues reported that disrupting these vessels in mice reduced the clearance of toxic amyloid-β proteins and accelerated cognitive decline3.
Qingping Xie (right) talks with Wei Chen (left) at the Cleveland Clinic.Credit: ANQI XIE
These findings suggested that the brain has a previously overlooked waste-clearance network. They also complemented earlier research by neuroscientists Jeff Iliff and Maiken Nedergaard at the University of Rochester Medical Center in New York. In 2012, the researchers described fluid-filled channels alongside blood vessels that move fluid through brain tissue and help remove waste4.
Xie reasoned that if waste from the brain eventually drains through lymphatic vessels in the neck, improving that outflow could potentially enhance waste clearance throughout the brain. If impaired drainage contributes to neurodegenerative disease, restoring the flow might offer a new approach to Alzheimer’s treatment. The 84-year-old man featured in Xie’s video became his first test case.
Weifeng Zeng first learned about Xie’s work in February 2023 through a China Medical News bulletin listing the “Seven major advances in microsurgery in 2022”. Xie’s dcLVA technique ranked sixth. The bulletin said that Xie had already performed the procedure on more than 60 people.
Zeng, a reconstructive microsurgeon at the University of Wisconsin–Madison, tracked down Xie’s report and called the mobile number listed for the corresponding author. Xie answered immediately. He was eager to discuss his surgical experience and pleased to learn that Chen and Zeng had been considering the potential of lymphatic surgery for Alzheimer’s disease for more than a decade, although they had not yet performed the operation.
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The researchers soon began a formal collaboration. Xie travelled to Cleveland, where he demonstrated the dcLVA technique on cadavers for Chen’s team. Chen incorporated Xie’s clinical observations into conference presentations. The two surgeons, along with Zeng and other colleagues, later co-authored a report describing the procedure and its early outcomes. The report, published in the official journal of the American Society of Plastic Surgeons, included the video of Xie’s first patient5.
Interest in dcLVA spread rapidly in China and internationally. Surgeons travelled to Hangzhou to observe the operation, including J Mocco, a cerebrovascular neurosurgeon at Weill Cornell Medicine in New York City. He visited Qiushi Hospital in August 2025.
“I had never seen anything like it,” Mocco says.
“My first thought was: am I seeing a revival-tent preacher experience here?” he says. “But I came away from the visit to China saying: I don’t know if this is real, but it should be investigated in a rigorous and meaningful way to determine if it is.”
What the evidence says about the Alzheimer’s surgery
Most of the evidence for dcLVA comes from small studies conducted in China. Many were carried out at a single hospital, did not include a control group and provided limited evidence about how the surgery might produce clinical benefits.
More than a dozen reports involving several hundred participants have now been published. Taken together, they suggest that dcLVA may reduce levels of amyloid-β and tau proteins in cerebrospinal fluid while producing modest improvements in memory, attention and other cognitive measures. However, dramatic recoveries like the one shown in Xie’s original video continue to be reported in China and elsewhere.
“We are seeing some incredibly encouraging data,” says Joon Pio (JP) Hong, a plastic surgeon at the University of Ulsan College of Medicine in Seoul. He worked with Xie on a report published last year involving a 58-year-old woman with severe Alzheimer’s disease. Before surgery, she could barely walk; afterwards, she was able to move without assistance6. Hong is now conducting his own clinical trial in South Korea. He says some participants have shown striking gains, although the response has not been universal.
Brain’s drain
Similar patterns are emerging from larger and more rigorous studies. In February, clinicians published results from more than 100 people with severe Alzheimer’s disease who underwent dcLVA at the First People’s Hospital of Zunyi in southwestern China. During several months of follow-up, participants showed modest average improvements in cognitive and functional scores, along with lower amyloid-β and tau levels in cerebrospinal fluid7.
Independent imaging research provides some preliminary support for these findings. MRI scans taken before and after surgery have shown increased connectivity in the brain’s default mode network, which plays an important role in memory-related activity8. Ultrasound scans have also indicated increased blood flow through the jugular veins and carotid arteries in the neck9.
These results could indicate improved circulation and brain connectivity, but they do not establish that dcLVA modifies the underlying disease. Caregiver interviews from a formal study in China’s Henan province offer little additional clarity10. Reported benefits were often subtle and inconsistent, and could have been influenced by expectations or emotional investment. Several clinicians also say they have heard from colleagues in China that many patients decline again within a year, raising questions about whether any improvement is temporary.
Will the benefits of dcLVA last?
The durability of the treatment remains one of the biggest unanswered questions in Alzheimer’s research.
Kipnis doubts that the improvements will necessarily be permanent. He compares dcLVA with a road detour that temporarily redirects traffic without removing the original blockage. The surgery might improve the flow of brain waste for a period, he says, but the underlying cause of impaired drainage could remain. “The system will get clogged again and again,” warns Kipnis, who is based at Washington University School of Medicine in St. Louis, Missouri.
For families facing severe dementia and limited treatment options, even short-term improvements could be significant, says JP Hong. “If the patient is able to improve even for a year, that’s a whole freaking miracle for the patient and their family.” Both Hong and Kipnis consult for Medical Microinstruments (MMI), a surgical robotics company based in Jacksonville, Florida, which is supporting a 15-person dcLVA study in the United States.
The speed of the reported improvements is another source of uncertainty. “The thing that doesn’t fit for me is the fact that the effects seem relatively immediate,” says Iliff, now at the University of Washington School of Medicine in Seattle and a paid consultant for MMI. “I have a hard time understanding how those kinetics work.”
The future of Alzheimer’s treatment
One possibility is that improved drainage reduces pressure in fluid-filled spaces around the brain, easing stress on surrounding tissue and temporarily improving cognitive function. The surgery could also help remove inflammatory molecules and other toxic metabolites that impair neurons and disrupt synapses. Another possibility is that dcLVA rapidly clears soluble forms of amyloid-β and tau, while leaving behind the plaques and tangles associated with Alzheimer’s disease.
Source: www.nature.com