Integrated device for optoacoustically-guided ultrasound surgery.

High-intensity focused ultrasound has emerged as a promising tool for treating tumors and other pathologies by inducing localized thermal lesions. However, treatment outcomes depend strongly on accurate coverage of the treated region and monitoring lesion formation in real time. While magnetic resonance imaging has successfully been used to guide high-intensity focused ultrasound therapy, it significantly increases the cost and complexity of the treatment. To address these limitations, we have developed a system that integrates real-time three-dimensional tomographic optoacoustic imaging with concurrent focused ultrasound emission using a high-frequency spherical array transducer. We evaluated the performance of the system in the mouse brain ex vivo and further assessed its clinical translatability in a living sheep, demonstrating successful induction of a confined thermal lesion beneath the cortical surface, as confirmed by magnetic resonance imaging and histology. The system enabled precise treatment targeting, while optoacoustic signal changes during sonication provided a reliable indicator of thermal lesion progression. This capability allowed on-the-fly adjustment of the thermal dose, helping to minimize the risk of vascular damage or adverse effects on off-target structures.