Abstract: A precision forward-looking image-guided diagnostic and therapeutic surgical probe and needle insert for microsurgery in support of imagery, neurology, neurosurgical procedures, and ophthalmic surgical applications comprising an introducer needle (stylet), a fiber carrier, a therapeutic conduit, and a spirographic method for scanning a target and associated algorithms to create and render a reconstructed image for display to a physician in real-time or near real-time. The probe implements Optical Coherence Tomography (OCT) to provide high-resolution extended imagery of an intended therapeutic or target tissue. A separate therapeutic conduit provides surgical access for therapeutic devices such as a cutting or ablation laser, an RF electrode for locally heating tissue, a lumen for local injection of neurolytics/paralytics, placement of electrodes for neuromodulation, and deployment of a micro-endoscopic imaging tool. A third working channel supports the delivery of neurolytic and other fluids.