Intraoperative image-guided surgical navigation for craniospinal procedures has significantly improved accuracy by providing an avenue for the surgeon to visualize underlying internal structures corresponding to the exposed surface anatomy. Despite the obvious benefits of surgical navigation, surgeon adoption remains relatively low due to long setup and registration times, steep learning curves, and workflow disruptions. We introduce an experimental navigation system utilizing optical topographical imaging (OTI) to acquire the 3D surface anatomy of the surgical cavity, enabling visualization of internal structures relative to exposed surface anatomy from registered preoperative images. Our OTI approach includes near instantaneous and accurate optical measurement of >250,000 surface points, computed at >52,000 points-per-second for considerably faster patient registration than commercially available benchmark systems without compromising spatial accuracy. Our experience of 171 human craniospinal surgical procedures, demonstrated significant workflow improvement (41 s vs. 258 s and 794 s, p < 0.05) relative to benchmark navigation systems without compromising surgical accuracy. Our advancements provide the cornerstone for widespread adoption of image guidance technologies for faster and safer surgeries without intraoperative CT or MRI scans. This work represents a major workflow improvement for navigated craniospinal procedures with possible extension to other image-guided applications.

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Real-time depth metrology during material removal via laser ablation is useful in many forms of laser machining. Until now, coaxial optical coherence tomography (OCT) metrology was achieved by the coupling of an OCT imaging beam and ablating beams using a dichroic filter. We present an alternative design with all fiber delivery that is more suitable for surgical laser ablation applications. The novel system design integrates a high peak-power pulsed Yb-doped fiber laser (1064nm) coupled directly into the sample arm of a swept-source OCT system (λ c = 1310nm). We measured the OCT signal degradation due to dispersion and attenuation through the ablation fiber laser cavity. Ablation progression is measured in real-time using M-mode OCT. The mean depth targeting error was found to range from 10µm to 80µm in phantom ablation experiments and 21µm to 60µm in bone ablation. A number of issues have been solved, including point-spread function (PSF) peak broadening due to signal delay and dispersion, high bending loss due to dissimilar fiber used throughout the design, and problems due to the extremely high ablation power to swept-source power ratio (> 2x10 4 peak to average power). To our knowledge, this is the first demonstration of thermal-mediated laser ablation drilling integrated with coaxial OCT imaging through a single-mode, single-cladded output fiber, without using dichroic beam splitters or free-space optic filters anywhere in the optical path and with this high ablation laser power to OCT source power ratio. The removal of bulk optics compared to existing designs opens a new path for compact integration of the entire system. Also, since the ablation laser and OCT feedback system exist along the same fiber path, the need for maintenance and repair are greatly reduced since spatial beam alignment and the potential open-air contamination of optical surfaces are virtually eliminated. We believe that this integrated system is a great candidate for adoption in depth-controlled surgical ablation applications.