Ultrasound-guided muscle dissection for lumboperitoneal shunting via lateral abdominal laparotomy

Purpose;Lumboperitoneal shunting (LPS) is a common procedure for treating idiopathic normal pressure hydrocephalus (iNPH), involving two abdominal approaches:anterior abdominal laparotomy and lateral abdominal laparotomy (LAL). While LAL is advantageous in terms of infection risk, it presents challenges such as muscle manipulation and potential deviation from the desired trajectory. This report presents a novel technique that utilizes ultrasound examination of the lateral abdominal wall (UELAW) to visualize the three muscle layers (external oblique, internal oblique, and transversus abdominis) before abdominal manipulation during LAL. Illustrative Case;An 83-year-old iNPH patient underwent LPS with this approach, ensuring precise alignment of the trajectory and successful access to the abdominal cavity. Following the procedure, the patient experienced an improvement in gait disturbance and was discharged without any surgical complications. Conclusion;The use of UELAW during LPS provides clear visualization of the abdominal muscle layers, allowing surgeons to perform the procedure with confidence and accuracy, minimizing the risk of trajectory deviation, and ultimately improving patient outcomes. J. Med. Invest. 71 : 343-345, August, 2024.