Abstract
BackgroundNo reports exist concerning in vivo optical coherence tomography visualization of the epidural space and the blood patch process in the epidural space. In this study, we produced real-time two-dimensional and reconstructed three-dimensional images of the epidural space by using optical coherence tomography in a porcine model. We also aimed to produce three-dimensional optical coherence tomography images of the dura puncture and blood patch process.MethodsTwo-dimensional and three-dimensional optical coherence tomography images were obtained using a swept source optical coherence tomography (SSOCT) system. Four laboratory pigs were intubated and ventilated after the induction of general anesthesia. An 18-gauge Tuohy needle was used as a tunnel for the optical coherence tomography probe to the epidural space. Two-dimensional and three-dimensional reconstruction optical coherence tomography images of the epidural space were acquired in four stages.ResultsIn stage 1, real-time two-dimensional and reconstructed three-dimensional optical coherence tomography of the lumbar and thoracic epidural space were successfully acquired. In stage 2, the epidural catheter in the epidural space was successfully traced in the 3D optical coherence tomography images. In stage 3, water injection and lumbar puncture were successfully monitored in all study animals. In stage 4, 10 mL of fresh blood was injected into the epidural space and two-dimensional and three-dimensional optical coherence tomography images were successfully acquired.ConclusionsThese animal experiments suggest the potential capability of using an optical coherence tomography-based imaging needle in the directed two-dimensional and three-dimensional visualization of the epidural space. More investigations involving humans are required before optical coherence tomography can be recommended for routine use. However, three-dimensional optical coherence tomography may provide a novel, minimally invasive, and safe way to observe the spinal epidural space, epidural catheter, lumbar puncture hole, and blood patch.
Highlights
Despite continual advancements in medical imaging technology, several problems make noninvasive direct visualization of the spinal epidural space (ES) without radiation exposure difficult to attain
In stage 2, the epidural catheter in the epidural space was successfully traced in the 3D optical coherence tomography images
In stage 4, 10 mL of fresh blood was injected into the epidural space and two-dimensional and three-dimensional optical coherence tomography images were successfully acquired
Summary
Despite continual advancements in medical imaging technology, several problems make noninvasive direct visualization of the spinal epidural space (ES) without radiation exposure difficult to attain. Optical coherence tomography (OCT) [3], which does not involve any radiation, can provide high-quality real-time images with a high discriminative ability (15 μm or better). No report exists concerning real-time in vivo OCT visualization of the ES. No study has used OCT to demonstrate the blood patch process in the ES. No reports exist concerning in vivo optical coherence tomography visualization of the epidural space and the blood patch process in the epidural space. We produced real-time two-dimensional and reconstructed three-dimensional images of the epidural space by using optical coherence tomography in a porcine model. We aimed to produce three-dimensional optical coherence tomography images of the dura puncture and blood patch process
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