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

Abstract 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.