[Direct observation of the epidural space by the superfine fiberscope]

The anatomy of the epidural space was examined in 82 patients 3 to 90 years old who had indications of epidural anesthesia. The superfine fiberscope with an outer diameter of 0.8 mm was utilized for this study. It was advanced through 18 gauge Tuohy needle inserted into the epidural space. All findings were documented by videography. The epidural space was located at the thoracic intervertebral space (52 patients), at the lumbar interspace (27 patients) and at the caudal space (3 patients), using an 18-gauge Tuohy needle with either median or paramedian approach. The epidural space was identified by either hanging drop or loss of resistance method. 65 of 82 cases gave a clear view of epidural space. The epidural space presented as either a space that opened widely or a space that was occupied with large masses of fat. Vessels were encountered on the dura and the flaval ligaments, as well as in the connective tissue. Large amounts of connective tissue were present in all cases. No complications, such as accidental dural puncture, epidural hematoma, infection, nerve injury attributed to this technique were observed.