Deep cervical lymphaticovenous anastomosis for Alzheimer disease: A critical narrative assessment and translational framework.

Deep cervical lymphaticovenous anastomosis (dcLVA) has been proposed to augment cerebral waste clearance in Alzheimer disease. This critical narrative assessment examines the mechanistic premise, available human reports, registered studies, and governance implications. Experimental loss-of-function and gain-of-function studies support a role for meningeal lymphatics in brain-fluid homeostasis, but they do not establish a rate-limiting cervical outflow abnormality in human Alzheimer disease. The clinical reports identified through this narrative search were uncontrolled single-arm investigations, including patients with severe impairment, substantial attrition, and outcomes vulnerable to floor effects and perioperative influences. Randomised studies are now recruiting. Their value will depend on whether they measure intervention-specific flow, target engagement, clinically meaningful outcomes, and harms. The procedure should remain investigational until studies demonstrate intervention-specific biological target engagement, controlled clinical benefit, and acceptable long-term safety.