<i>Lymphspiration</i>: Systemic Echoes - Can Lymphatic Reconstruction Surgery Extend its Therapeutic Reach from Limbs to Head.

This case series highlights potential systemic effects of lymphaticovenular anastomosis (LVA) with conventional treatment in patients with primary lymphedema of the lower limb, with a particular focus on its implications for cerebral lymphatic function. We present two cases in which LVA performed on a lower limb led to interesting systemic improvements extending beyond the treated regions, including alleviation of preoperative cognitive symptoms. The first case involves a 37-year-old woman with diffuse body swelling, including facial edema. LVA in her left leg resulted not only in re-duction of swelling but also in marked improvement in speech and mentation. The second case describes a 62-year-old woman who, following LVA in her right leg, experienced resolution of limb and facial edema, relief of oropharyngeal symptoms, and improvement in cognitive function. Although these cranial improvements were not objectively assessed due to lack of measurement before the LVAs, they were subjectively perceived by the patients post-operatively. These reports indicate the systemic nature of primary lymphedema and interestingly suggest that peripheral lymphatic surgery and treatment may positively influence cerebral lymphatic dynamics.