Adult neurons from Caenorhabditis elegans can extrude large membrane-surrounded vesicles, known as exophers, containing protein aggregates and dysfunctional organelles that threaten neuronal homeostasis. Monica Driscoll and colleagues show that in the nematode Caenorhabditis elegans, adult neurons are able to extrude large membrane-surrounded vesicles, dubbed exophers, that may contain protein aggregates and organelles. Inhibiting chaperone expression, autophagy or the proteasome, or compromising mitochondrial quality, results in increased exopher production. Proteotoxically stressed neurons that extrude exophers subsequently function better than similarly stressed neurons that do not. These data suggest that exopher-genesis is a potential cellular 'garbage-removal' response. The toxicity of misfolded proteins and mitochondrial dysfunction are pivotal factors that promote age-associated functional neuronal decline and neurodegenerative disease1,2. Accordingly, neurons invest considerable cellular resources in chaperones, protein degradation, autophagy and mitophagy to maintain proteostasis and mitochondrial quality3,4. Complicating the challenges of neuroprotection, misfolded human disease proteins and mitochondria can move into neighbouring cells via unknown mechanisms, which may promote pathological spread5,6. Here we show that adult neurons from Caenorhabditis elegans extrude large (approximately 4 μm) membrane-surrounded vesicles called exophers that can contain protein aggregates and organelles. Inhibition of chaperone expression, autophagy or the proteasome, in addition to compromising mitochondrial quality, enhances the production of exophers. Proteotoxically stressed neurons that generate exophers subsequently function better than similarly stressed neurons that did not produce exophers. The extruded exopher transits through surrounding tissue in which some contents appear degraded, but some non-degradable materials can subsequently be found in more remote cells, suggesting secondary release. Our observations suggest that exopher-genesis is a potential response to rid cells of neurotoxic components when proteostasis and organelle function are challenged. We propose that exophers are components of a conserved mechanism that constitutes a fundamental, but formerly unrecognized, branch of neuronal proteostasis and mitochondrial quality control, which, when dysfunctional or diminished with age, might actively contribute to pathogenesis in human neurodegenerative disease and brain ageing.