Intraoperative Fast Adaptive Focus Tracking Robotic OCT Enables Real-Time Tumor Grading and Large-Area Microvascular Imaging in Human Spinal Cord Surgery.

Current surgical procedures for spinal cord tumors lack in vivo high-resolution multifunctional imaging systems, hindering precise tumor resection. This study introduces the fast adaptive focus tracking robotic optical coherence tomography (FACT-ROCT) system, which provides real-time, artifact-free imaging during surgery, addressing motion artifacts and resolution degradation. Imaging occurs in 22 patients, including 13 with gliomas (WHO grade I-IV). This represents the first in situ OCT imaging of human spinal cord tumors, enabling the differentiation of tumor types in real-time. The standard deviation of the attenuation coefficient serves as a physical marker, achieving 90.2%  ±  2.7% accuracy in distinguishing high- from low-grade gliomas intraoperatively at a threshold of 0.75  ±  0.01 mm-1. FACT-ROCT also enables microvascular imaging, covering areas of 70 mm × 13 mm × 10 mm within 2 min and revealing greater vascular tortuosity in higher-grade tumors. This extensive imaging capability provides critical information that guides surgical strategies, enhancing surgical outcomes. Overall, FACT-ROCT represents a significant advancement in intraoperative imaging, offering high-resolution, high-speed, and comprehensive insights into spinal cord tumor structure and vasculature.