The man who developed a surgery to treat Alzheimer’s disease has been detained by Chinese authorities for a year and we don’t know why.
According to reporting done by Elie Dolgin for Nature, there are rumours of financial impropriety. The surgeon’s daughter thinks it has something to do with the surgery he pioneered and which appears to be revolutionary.
On its surface, it has the making of yet another medical conspiracy sure to get clicks. Alzheimer’s disease is the most common form of dementia, and dementia as a whole affects a little over 7% of Canadians—a pretty stunning number. What if it could be boiled down to a plumbing issue in the brain that could be relieved via an unorthodox surgical procedure, and what if the brilliant man behind this salvation was, like Galileo, punished by the authorities?
This is a story that demands to be approached with skepticism. There is no consensus right now on whether or not the surgery really works: the studies are small, lack control groups and long-term follow-up, and much of the “how it works” has not been sufficiently explained.
On top of that, there’s an irritating feeling of déjà vu that people familiar with multiple sclerosis may experience as they learn about a new surgery meant to unclog the body’s pipes.
Serendipitous supermicrosurgery
The surgeon at the centre of this story is Dr. Qingping Xie (whose last name is roughly pronounced “see-uh”). Based in East China, he is a reconstructive surgeon who specializes in procedures done on tiny structures in the body using a microscope.
This field has made impressive leaps in the last few decades. Microsurgery was developed in the 1960s, but at the turn of the millennium, the Japanese surgeon Isao Koshima pioneered a reliable technique to go even smaller. It would earn the name “supermicrosurgery,” and it involves the cutting and connecting of small tubes (like blood vessels) ranging in diameter between 0.3 and 0.8 millimetre. For comparison, the smallest distance you can measure with a school ruler is 1 millimetre.
This painstaking type of surgery requires an incredible coordination between the eye, the microscope, and the hand; surgical robots can help, but their movements are limited. Supermicrosurgery’s big claim to fame is helping lopped-off fingertips get reattached so they can be functional again.
But surgery is not a procedure we associate with Alzheimer’s disease. Indeed, this whole story began with serendipity. Xie was operating on a woman who had tinnitus—a persistent ringing inside the brain. Her condition appeared to be due to something pressing on the nerves involved in her hearing. While relieving the pressure surgically, Xie noticed something else. It had to do with her lymphatic vessels.
Blood vessels, like arteries and veins, are not a foreign concept; but what many people may not know is that our bodies have a parallel structure of vessels called the lymphatic system. It is, to put it crudely, our version of a sewage network—picking up dead cells and waste products, filtering them out of the liquid, and returning the clear fluid to the circulation. This system also plays an important role in our immune system.
Deep in his patient’s open neck, Xie observed abnormalities in parts of her lymphatic system. He used a technique that supermicrosurgeons had developed to relieve swelling in people with lymphedema: he artificially connected tiny lymphatic vessels to nearby veins. The idea was to drain lymphatic structures in her neck more efficiently. Not only did his patient’s tinnitus improve but so did her mental sharpness.
While Xie had made anatomical connections on the operating table, his mind started to make other connections. Lymphatic vessels existed throughout the body, sure; yet until recently, we thought the brain was devoid of them. Brain trash was thought to be slowly chewed up inside of brain cells or to very slowly pass through the blood-brain barrier, a special sheath that surrounds the vessels carrying blood to the brain and that acts as a sort of passport control. But surprise, surprise: a decade ago, scientists discovered that the brain did have its own lymphatic system, one that partially runs through the meninges, those thin membranes protecting our brain and spinal cord.
The uncovering of this plumbing system inside the brain made Xie wonder: what if the microscope-assisted draining he had done for his patient could be done for Alzheimer’s disease?
Operating on the neck to save the brain
Dementia is brutal: a general loss of the ability to think; an erosion of memories; an impaired judgment; and ultimately a vanishing of the self. Medications exist to manage the condition, but doctors are far from having a truly effective armamentarium. In Alzheimer’s, a protein gets chopped up into fragments called amyloid-beta (also called beta-amyloid or b-amyloid) that tend to accumulate inside the brain. This facilitates the aggregation of another protein, tau (rhymes with “pow”). It’s still unclear if these molecules cause the disease or if they are consequences of it, or if they are merely the most visible pair of culprits. Is this accumulation, Xie pondered, simply due to backed-up pipes? Could he connect these pipes differently to facilitate the clearance of these protein aggregates?
In September 2020, at the height of the COVID-19 pandemic, an 84-year-old man with Alzheimer’s dementia was operated on by Qingping Xie. As with his tinnitus patient, the doctor opened up the man’s neck and connected a few of the lymphatic vessels to veins in order to improve drainage. Operating inside the brain would undoubtedly have been more dangerous, more invasive, and its lymphatic vessels tend to be too small for supermicrosurgery anyway; Xie later claimed that the lymphatic system responds “as a unified organ,” meaning that when you operate on one of its parts, the entire structure benefits. Rearrange the pipes in the neck, goes the thinking, and the sewage backup in the brain will get cleared up.
The surgery is called deep cervical lymphatic-venous anastomosis (dcLVA), that last word meaning a connection between two structures. And the results were, according to the medical team, dazzling.
Reasons for skepticism
You can see brief video clips of a similar man, this one aged 76, after the dcLVA surgery, and the word “miraculous” comes to mind. Before the operation, he is described as unable to recognize his family, to sit, or to walk. After a 30-minute operation in which a few lymphatic vessels in his neck were connected to veins, he is now apparently able to recognize his relatives, speak clearly, and walk assisted. Eight months later, he can even stroll about unassisted and take care of himself.
It’s no wonder that hundreds of hospitals in China started offering the surgery and advertising it on Chinese social media. Desperate caregivers were said to shell out over US$ 30,000 to have their loved on operated on, according to one report. But in mid-2025, Chinese authorities cracked down: dcLVA can now only be conducted in China as part of a clinical research project approved by an ethics committee. The toothpaste has been squeezed back into the tube.
There are reasons to doubt that this surgery is truly beneficial to patients with Alzheimer’s dementia. Explaining all diseases as plumbing issues and blockages reeks of pseudoscience. It is the bugaboo of acupuncture, chiropractic, and Reiki, a misguided oversimplification of biology. But sometimes, things really are backed up in the body and relief is needed.
However, we need solid evidence, and the studies that have been published have not been large. Alzheimer’s dementia does not progress the same in everyone. With a small group of patients, you may accidentally stumble upon enough people whose symptoms would have briefly lifted even without the operation.
The absence of a control group, receiving a similar surgery that does not link up lymphatics with blood vessels, is also problematic. I am reminded of certain knee surgeries that were, for a long time, thought to be beneficial... until they were finally compared to a sham version, and surgeons saw there was no difference (here is one of many examples). People may improve after surgery for a variety of reasons that have nothing to do with what the surgeons specifically did.
Some doctors have also argued that a drug called dexmedetomidine, commonly used to induce anesthesia during dcLVA, can temporarily boost the lymphatic system of the brain—at least in laboratory animals. Without a control group that received it but did not have its tubes played with during surgery, we don’t know what really caused any improvement seen right after the operation.
Improvements could likewise be due to the relief of another problem. That very first case study published in the literature had Alzheimer’s disease, sure, but also a history of brain bleeds. Might neck surgery not have relieved some remaining pressure and thus made the man better, at least in the short term?
Finally, it’s worth pointing out that we cannot definitely rule out exaggerations or outright fraud, such as the selective publication of cases that improved and the burying of those that did not. I have personally administered the Montreal Cognitive Assessment (MoCA) as part of a research project. The MoCA is a screening questionnaire to evaluate if someone needs to be seen for a possible cognitive impairment. When I read a translation of the original case report by Xie on his patient who went from scoring 2 out of 30 on the MoCA pre-op to receiving a whopping 13 out of 30 after the operation, I found this hard to believe, especially after only three anastomoses were done in his neck. The immediacy of the improvement—so soon after surgery—also beggars belief.
Now, before you think that all of the evidence presented to us is positive, let me drag in the mud from many of the papers I read. Often, MoCA scores and the likes do not significantly go up after the operation. And when 20 caregivers were asked how the surgery had changed the person they were caring for, reports were all over the map. “On the fifth day after surgery, she called me by name—I cried,” said one. Stop here and you’ve got yourself a miracle. But keep scrolling and you read the following two quotes from other caregivers:
“She was alert for a couple of days, then back to before.”
“She became slower and more vacant after the surgery.”
Learning about this operation, I couldn’t help but wonder why it sounded so familiar, and I found myself thinking about the large vehicle used to resurface the ice of a skating rink.
Liberation therapy
The Italian researcher’s name was Paolo Zamboni—no obvious relation to the ice rink machine. His wife was diagnosed with multiple sclerosis, a disorder where the immune system attacks the sheath that protects nerve cells. In the mid-2000s, he took a wild swing. He hypothesized that multiple sclerosis was due to a narrowing of certain veins in the neck, which meant that the brain couldn’t drain properly. Sounds familiar? He called his hypothesis chronic cerebrospinal venous insufficiency, and he devised a surgery—called liberation therapy—that relied on opening up the veins in the neck. Again, sounds familiar?
Hope was whipped up and the idea caught on, especially in Canada where we have more cases of multiple sclerosis than would be expected given our population size. Unfortunately for patients, Zamboni’s claim that narrowed neck veins were only seen in multiple sclerosis patients was proven to be highly unlikely. His theory does not pass muster, which is why his surgery has not become standard of care.
Just because Zamboni’s declogging surgery is unlikely to work for multiple sclerosis does not automatically mean that Xie’s declogging surgery for Alzheimer’s disease cannot work. But given the hype around Zamboni’s early successes—it really did seem to work!—we should learn a lesson and dial down the enthusiasm the second time around.
I think the Chinese authorities were right to restrict dcLVA to clinical studies and not to allow it to be offered as a routine surgery. It should be adequately studied and its risks need to be documented. So far, most studies report no safety issue... except that earlier this year, a case report was published where a patient developed a fever, hemorrhage, seizures, and altered consciousness after the surgery. Making new connections in the neck between lymphatics and blood vessels carries many potential risks: damage to the cardiovascular system, infection, leakage of lymph in the neck. In a rush to push this new surgery as a lifeline, surgeons could be selective in what they publish to make it appear safer. After all, this surgery represents an important potential expansion of the scope of practice of plastic surgeons, who have had nothing to do with Alzheimer’s disease so far. If dcLVA is proven to be effective—and not just for Alzheimer’s, but also for Parkinson’s and other neurological diseases, as some have wondered—it would effectively create a new subspecialty for these surgeons, which means new ways of making money.
Yet, even if the underlying idea of clogged pipes is proven right, surgery may not be the answer—especially since this type of surgery requires a very high skill set. There are drugs that could potentially help with “lymphatic tone,” ensuring that the sewage lines inside the brain don’t get congested so easily. And if we’re willing to stretch credulity some more, neck massages have also not been ruled out. A preprint from last year (meaning a paper that has not yet undergone review by other scientists) used manual lymphatic drainage via massage on a group of special mice that mimic the symptoms of Alzheimer’s disease. (Yes, a graduate student can now add “mouse masseuse” to their CV, especially since they had to rub those rodents down for 67 days.)
I would be shocked if a viable treatment for Alzheimer’s disease turned out to be neck massages to get the fluids moving, but don’t be surprised when quacks, unable to offer supermicrosurgery in their incense-infused offices, begin to charge for lymphatic drainage for Alzheimer’s disease. You’ll know where they got the idea from.
Dr. Qingping Xie’s year-long detention by the Chinese government without a stated reason can only fuel conspiracy thinking that they don’t want us to know that a cure for a common form of dementia has been discovered.
I am not hopeful that this surgery is all it is claimed to be, but I do look forward to being proven wrong. Dementia is one of the worst ways a life can end, and if someone stumbled upon an effective treatment while playing inside the neck of woman with tinnitus, I’ll lend an ear. Until solid scientific evidence is presented and it passes muster, we must be neither gullible nor knee-jerk dismissive; skepticism is the happy middle ground.
After all, as a great leader once said, “Fool me once... shame on... shame on you. It fool me—can't get fooled again.”
Take-home message:
- A new surgery was devised in China to treat Alzheimer’s disease.
- It is based on the unproven theory that improving drainage of brain fluids through the neck will clear up the proteins that accumulate in the brain of Alzheimer’s patients.
- Skepticism is warranted, as the studies have been small, lack control groups, and the reported improvements appear too good to be true.
