Dr. Daniel Maliszewski, MD, surgeon at the Provincial Specialist Hospital in Słupsk, will be the main operator of the first operation on a patient with Alzheimer's disease. It is to be carried out in October.
How long will the surgery take?
We should be after the first treatment within a week or two. We will operate in a team with Ewa Migacz, M.D., a specialist in laryngology, who provides support in the team in the field of head and neck anatomy and microsurgery, Daniel Maliszewski, M.D., told PAP.
The plan is to complete the procedure within three or four hours because the patient will be operating on a neurological condition. We have the approval of the bioethics commission, the first in Poland and the first such in-depth approval in the European Union, Dr. Maliszewski told PAP.
A prolonged procedure is always an additional risk factor - postoperative delirium, which may occur. We will try to shorten the time of this procedure and adjust the techniques to achieve this - noted the surgeon.
Modern equipment will help with the procedure
The procedure will use modern microsurgical equipment available at the Słupsk center.
We will operate based on indocyanine green, i.e. we will perform dye lymphography, which will show us the lymphatic channels. We will perform the procedure under a microscope, use ultrasensitive ultrasound, which is able to show us lymphatic ducts as large as 0.2-0.3 tenths of a millimeter, and use the Symani robot, said Maliszewski.
He emphasized that the surgery itself is not burdensome, so patients should recover quickly. However, it should be remembered that a neurological patient will require perioperative care, including the presence of family before and after the procedure.
Will it be possible to stop the disease?
The expected effect of the procedure is primarily clinical improvement in the patient and stopping the development of the disease.
At the same time, Maliszewski emphasized that the pathomechanisms of Alzheimer's disease are not fully known.
The most likely, according to experts, is the storage of tau and amyloid proteins in the nervous system, which causes neuronal degeneration as a result of increased concentrations. Work on the surgical technique to improve the outflow of harmful metabolites from the brain began around 2021, after the presence of the lymphatic system within the brain was confirmed in 2017. So we know that this system is responsible for the removal of harmful metabolites from the central nervous system. Indirect evidence suggests that it is also responsible for the disposal of this tau protein and amyloid. We also know that it is inefficient or overloaded in this group of patients with neurodegenerative diseases. The idea is to support it and relieve it using microsurgery and super-microsurgery techniques, said Maliszewski.
Currently, two centers are leading in research, procedures and analyzes of the use of surgical methods supporting the treatment of neurodegenerative diseases - ASAN Medical Center in South Korea and Cleveland Clinic in the USA. The Taiwanese and Chinese also operate.
Queue of patients
The first patient in Poland will be operated on in Słupsk. There are three more out of 40 diagnosed and selected from over 100 registered. They have passed the final qualification conducted by a neurologist, Dr. Hab. n. med. Kamil Chwojnicki. He commissions, among others: blood biomarkers, which allows for less invasive confirmation and monitoring of Alzheimer's disease.
From the analyzes of the procedures performed so far, it is known, as Maliszewski emphasized, that surgical methods bring improvement and effectively support the treatment of patients with diagnosed neurodegenerative diseases, the most common being Alzheimer's disease, there are also reports in the field of Parkinson's.
There are patients in whom the effects are very good, and those in which they are, but much smaller. We are looking for the group for which the benefits will be felt the most. We are looking for the appropriate indication, indirect factors, which may be the stage of the disease, sleep activity, and the number of metabolites. There may be more. We are looking. Each subsequent month provides new data and new results that allow for better selection of patients, the surgeon noted.
