en Vascular Neurosurgery Review Alzheimer’s disease (AD) is a major public health challenge. The exact cause of AD is unknown, but it is characterized by progressive impairment in cognitive and memory functions and pathological changes in the brain, such as aggregation of two main proteins, amyloid-beta (Aβ) and neurofibrillary tangles (NFTs) of tau. Nonetheless, the pathogenesis of AD appears to be complicated by vascular changes, neuroinflammation, synaptic loss, and impaired clearance of cellular waste products. Currently, the limited efficacy of available treatments underscores the need for alternative therapeutic strategies. The glymphatic system is a paravascular network in the central nervous system, responsible for the removal of cellular waste. The present review discusses the glymphatic system and its reconstructive surgery as a potential treatment approach for AD. Both experimental and human studies have demonstrated the role of the impaired glymphatic system in the pathogenesis of AD by increasing the accumulation of Aβ and tau proteins, thus holding potential as a new target for AD treatment. Moreover, glymphatic system dysfunction can lead to neurodegeneration, cognitive decline, and disease progression. Studies have also shown the potential role of microsurgical lymphatic reconstruction as a possible therapeutic target for AD treatment. Glymphatic system dysfunction may be a possible contributing factor to the pathogenesis and progression of AD. Moreover, glymphatic and meningeal reconstruction microsurgery may have the potential for the treatment of AD. Glymphatic Clearance Pathway, Glymphatic System Reconstruction, Alzheimer’s Disease 0 0 http://irjns.org/browse.php?a_code=A-10-728-4&slc_lang=en&sid=1 Ashkan Asgari Gashtrodkhani 100319475328460012539 100319475328460012539 No School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Roxana Kaveh 100319475328460012540 0009-0008-6537-6929 No Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. Zoheir Reihanian 100319475328460012541 100319475328460012541 No Department of Neurosurgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Shahrokh Yousefzadeh-Chabok 100319475328460012542 100319475328460012542 No Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. Sasan Andalib sasan.andalib@health.sdu.dk 100319475328460012543 100319475328460012543 Yes Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran.