Gerota versus Zuckerkandl: the renal fascia revisited.

Chesbrough, R M; Burkhard, T K; Martínez, Antonio J. Zoido; Burks, D D

doi:10.1148/radiology.173.3.2682777

Cited by 58 publications

(21 citation statements)

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“…A common access point for the retroperitoneum is near the tip of the 12th rib, where layers merge. This single TLF layer anterolaterally merges with the aponeurosis of the transversus abdominis muscle 114) . The retroperitoneum can be entered from this point without incising muscle, which is an entry point for the conventional open anterior approach.…”

Section: Thoracolumbar Fascia (Tlf)mentioning

confidence: 95%

“…This becomes the fascia involved with the intestinal tract 113) . These embryologic strata categorize the retroperitoneal fasciae, which compartmentalize the spaces within the retroperitoneum 114) .…”

Section: Retroperitoneal Fascial Developmentmentioning

confidence: 99%

“…The TF may fuse medially with the posterior lamina of the posterior RF. This fusion creates the medial boundary of the posterior pararenal space 112,114) .…”

Section: Transversalis Fascia (Tf)mentioning

confidence: 99%

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Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

Kanemura

Satake

Nakashima

et al. 2017

Spine Surg Relat Res

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Abstract:Lateral approach spine surgery provides effective interbody stabilization, and correction and indirect neural decompression with minimal-incision and less invasive surgery compared with conventional open anterior lumbar fusion. It may also avoid the trauma to paraspinal muscles or facet joints found with transforaminal lumbar interbody fusion and posterior lumbar interbody fusion. However, because lateral approach surgery is fundamentally retroperitoneal approach surgery, it carries potential risk to intra-and retroperitoneal structures, as seen in a conventional open anterior approach. There is an innovative lateral approach technique that reveals different anatomical views; however, it requires reconsideration of the traditional surgical anatomy in more detail than a traditional open anterior approach. The retroperitoneum is the compartmentalized space bounded anteriorly by the posterior parietal peritoneum and posteriorly by the transversalis fascia. The retroperitoneum is divided into three compartments by fascial planes: anterior and posterior pararenal spaces and the perirenal space. Lateral approach surgery requires mobilization of the peritoneum and its content and accurate exposure to the posterior pararenal space. The posterior pararenal space is confined anteriorly by the posterior renal fascia, anteromedially by the lateroconal fascia, and posteriorly by the transversalis fascia. The posterior renal fascia, the lateroconal fascia or the peritoneum should be detached from the transversalis fascia and the psoas fascia to allow exposure to the posterior pararenal space. The posterior pararenal space, however, does not allow a clear view and identification of these fasciae as this relationship is variable and the medial extent of the posterior pararenal space varies among patients. Correct anatomical recognition of the retroperitoneum is essential to success in lateral approach surgery. Spine surgeons must be aware that the retroperitoneal membrane and fascia is multilayered and more complex than is commonly understood. Preoperative abdominal images would facilitate more efficient surgical considerations of retroperitoneal membrane and fascia in lateral approach surgery.

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Section: Thoracolumbar Fascia (Tlf)mentioning

confidence: 95%

Section: Retroperitoneal Fascial Developmentmentioning

confidence: 99%

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Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

Kanemura

Satake

Nakashima

et al. 2017

Spine Surg Relat Res

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“…1,[6][7][8]10 In many previous literature, configurations of the retroperitoneal planes have been analyzed by using cadaveric models and investigating the distribution of the thickened fascial planes and fluid collections in patients with retroperitoneal pathologies. 1,3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] However, there have been only two previous literature regarding the medial pathways of the right retromesenteric plane. 3,9 The right retromesenteric plane separating the anterior pararenal space from the perirenal space is thought to be composed of the left leaf of the primary mesocolon, primary parietal peritoneum and anterior renal fascia in front of the right kidney, and the right leaf of the primary mesoduodenum, primary parietal peritoneum and anterior renal fascia behind the pancreatic head and descending duodenum ( Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Medial pathway patterns of the right retromesenteric plane: anatomical investigation using MDCT in patients with acute pancreatitis and pyelonephritis

Takaji

Mori

Yamada

et al. 2016

BJR

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Objective: To investigate the medial pathways of the right retromesenteric plane by reviewing multidetector CT (MDCT) findings in patients with acute pancreatitis and pyelonephritis. Methods: 112 patients with acute pancreatitis and 114 patients with pyelonephritis underwent MDCT scans. 64 of the 112 patients with acute pancreatitis and 34 of the 114 patients with pyelonephritis had right retromesenteric plane thickening because of inflammatory extensions. The medial pathways of the right retromesenteric plane were evaluated by two radiologists in consensus. Results: In 18 (28%) of the 64 patients with acute pancreatitis and 10 (29%) of the 34 patients with pyelonephritis, the right retromesenteric plane continued to the central retroperitoneum behind the descending duodenum and pancreatic head (Type 1 pathway). The right retromesenteric plane extended to the right wall of the descending duodenum (Type 2 pathway) in 46 patients (72%) with acute pancreatitis and 24 patients (71%) with pyelonephritis. There was no significant difference in the pathway patterns of the right retromesenteric plane between the acute pancreatitis group and the pyelonephritis group (Type 1 pathway, p 5 0.89; Type 2 pathway, p 5 0.76). Conclusion: Two patterns were confirmed regarding the medial pathways of the right retromesenteric plane; this anatomical knowledge is important for evaluating the extension of retroperitoneal diseases. Advances in knowledge: Medial aspect of the right retromesenteric plane is thought to have two pathways. The right retromesenteric plane continuing to the right duodenal wall is a common type. Knowledge of these variations is important when evaluating the retroperitoneal diseases.

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“…The anterior and posterior laminae of the RF (or simply the anterior and posterior RFs -although this arose confusion in the past [Chesbrough et al, 1989]) -communicate mutually on each side behind the ascending and descending colon, where they connect to another layer, the so-called LF [Hinman, 1993]. The LF was noted in the posterior pararenal space or the paranephric space [Mitchell, 1950] between the posterior RF and the transversalis fascia (TF).…”

mentioning

confidence: 99%

Development of the Human Retroperitoneal Fasciae

Matsubara

Murakami²,

Niikura

et al. 2009

Cells Tissues Organs

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Introduction: Although the renal fascia (RF), ureteral sheath, lateroconal fascia (LF) and hypogastric nerve are critical landmarks for retroperitoneal surgery, their laminar relationships require clarification. Materials and Methods: Horizontal sections (hematoxylin-eosin staining) of human fetuses at two different developmental stages [9–12 (3 fetuses, crown-rump length, CRL 40–65 mm) and 20–25 weeks of gestation (9 fetuses, CRL 152–220 mm)] were compared. Results: In the early-stage group, the pararenal space had already formed between the posterior RF and the transversalis fascia (TF). The anterior RF extended along the peritoneum and often fused with the latter. In the late-stage group, the posterior RF extended inferomedially toward the anterior aspect of the aorta and inferior vena cava. However, at the level of the renal hilus, the posterior RF was connected with vascular sheaths of the great vessels. The LF was seen developing as a fasciculation of the multilaminar structure in the pararenal space. However, on the posterolateral side of the colon after retroperitoneal fixation, the fusion fascia of the peritoneum could also be identified as LF. Conclusions: A common sheath for ureters and hypogastric nerves appeared to be likely on the inferior side of the kidney. The LF did not appear to be a primary structure such as the RF, but a result of secondary mechanical stress due to fatty tissue developing earlier along the TF than in the perirenal space. However, the suggested similarity between LF and fusion fascia in the plane occupied was a likely cause for misinterpreting the laminar configurations during surgery.

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Gerota versus Zuckerkandl: the renal fascia revisited.

Cited by 58 publications

References 0 publications

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

Medial pathway patterns of the right retromesenteric plane: anatomical investigation using MDCT in patients with acute pancreatitis and pyelonephritis

Development of the Human Retroperitoneal Fasciae

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