Technical and perioperative management of bilateral deep cervical lymphovenous anastomosis in suspected cerebral amyloid angiopathy-related inflammation: A PHAIDRA case report

Deep cervical lymphovenous anastomosis (dcLVA) is being investigated to augment meningeal-cervical lymphatic outflow in Alzheimer's disease, but experience beyond biomarker-confirmed AD is limited. We report bilateral dcLVA in a 72-year-old woman with advanced dementia, aphasia and suspected cerebral amyloid angiopathy-related inflammation. Anesthesia was adapted to severe agitation and limited cooperation. Left side-to-end and right end-to-end anastomoses were completed without complication. From postoperative day 1, clinicians, nurses and her son observed reduced non-purposeful vocalization and intermittent gestural pain localization. At 195 days, her son reported persistence of this change without medication escalation. The case demonstrates feasibility, not efficacy. DRKS registration: DRKS00041335