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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\u00a0the 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.<\/jats:p>","DOI":"10.1038\/s41467-026-75692-4","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T07:55:15Z","timestamp":1784620515000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrated device for optoacoustically-guided ultrasound surgery"],"prefix":"10.1038","volume":"17","author":[{"given":"Isaac","family":"Esteban","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5450-4624","authenticated-orcid":false,"given":"Nima","family":"Mahkam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3980-9184","authenticated-orcid":false,"given":"Yi","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7675-9476","authenticated-orcid":false,"given":"Martha","family":"Gjikolaj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beat","family":"Werner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3696-6993","authenticated-orcid":false,"given":"Henning","family":"Richter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1823-7845","authenticated-orcid":false,"given":"Katrin","family":"Beckmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edin","family":"Nevzati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Coluccia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3274-7147","authenticated-orcid":false,"given":"Hikari A. 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