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First-in-Human Robot-Assisted Cervical Lymphatic Reconstruction for Neurodegenerative Disease: Early Neurological Recovery
Yazan Mahafza
*, Wei F. Chen
Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH
Purpose
Brain lymphatics established a clearance pathway connected to the deep cervical region. Impaired lymphatic drainage has been associated with aging, inflammation, vascular disease, and accumulation of pathogenic proteins in neurodegenerative disease. We report the first robot-assisted bilateral cervical lymph node-to-vein anastomoses (LNVA) in two patients with dementia secondary to Parkinson's disease (PD) and Alzheimer's disease (AD), both with coexisting head and neck lymphedema.
Methods
Two patients with PD and AD and concurrent head and neck lymphedema underwent bilateral cervical LNVA at the jugulodigastric lymph nodes. Three-dimensional stereolithographic modeling was used for localization. Target nodes were selected using indocyanine green lymphography and isosulfan blue dye mapping. Robotic assistance enhanced surgical precision. Outcomes were assessed with the Montreal Cognitive Assessment, Functional Activities Questionnaire, Dementia Severity Rating Scale, and Movement Disorder Society-Unified Parkinson's Disease Rating Scale.
Results
Both patients demonstrated cognitive improvement. The PD patient showed reduced edema, improved facial expressivity, normalized gait, improved handwriting, renewed ability to perform calculations, and discontinued hearing aid use on postoperative day 1. Family reported improvement in cognition, memory, affect, and motor coordination.
The AD patient, previously nonverbal and minimally responsive, demonstrated purposeful response to verbal stimuli within 24 hours. Coherent word production was observed. Caregivers reported decreased agitation, improved engagement, and enhanced affect within the first postoperative week.
Conclusion
These cases represent the first robot-assisted bilateral cervical LNVA procedures in patients with neurodegenerative disease and concurrent head and neck lymphedema. The findings support extracranial lymphatic reconstruction as a potential therapeutic strategy in neurodegeneration.
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