Objective: This systematic review aims to investigate the complications associated with MRgFUS (magnetic resonance-guided high intensity focused ultrasound) for neurological disorders and determine their frequency and nature to inform the potential expansion of this treatment to non-neurosurgeons.

Background: MRgFUS has been identified as an effective, incisionless treatment for various neurological conditions, including Parkinson’s disease and essential tremor (1). Despite its promise, it remains unclear whether any complications necessitate neurosurgical intervention. Expanding MRgFUS to appropriately trained non-neurosurgeons, particularly those skilled in stereotactic planning, could significantly enhance accessibility, especially in underserved areas. Historical precedent exists for transitioning procedures from surgical to non-surgical specialties, thereby increasing access to care (2). For instance, percutaneous coronary interventions are now routinely performed by interventional cardiologists (3), and colonoscopy by internists with the necessary training (4).

Method: A systematic literature search was conducted using PubMed/MEDLINE, Cochrane, and Scopus databases up to September 2024, adhering to PRISMA guidelines (5). Studies were included if they mentioned MRgFUS side effects in the context of neurological conditions. Out of the 12,963 studies screened, 548 underwent full-text review, and data was extracted from the 151 studies that met the predefined inclusion criteria, encompassing a total of 5,877 patients.

Results: The review found no reported side effects necessitating immediate or delayed neurosurgical intervention. Commonly reported side effects included gait disturbance (12.78% of patients), imbalance (8.46%), sensory changes (8.42%), headache (7.45%), paresthesia (6.04%), dysarthria (5.97%), ataxia (5.41%), dysmetria (3.88%), numbness (2.89%), nausea (2.88%), weakness (2.69%), dizziness (2.47%), and dysgeusia (1.80%), all of which were manageable by non-neurosurgeon healthcare providers.

Conclusion: Given the absence of side effects requiring neurosurgical intervention, this systematic review highlights the potential to transition MRgFUS procedures to being performed independently by neurologists and interventional radiologists, thus aiming to reduce barriers to care. However, this potential expansion warrants further investigation.

References: 1. Quadri S, Waqas M, Khan I, Khan M, Suriya S, Farooqui M, Fiani B. High-intensity focused ultrasound: past, present, and future in neurosurgery. Neurosurg Focus. 2018 Feb;44(2):E16. doi: 10.3171/2017.11.FOCUS17610. PMID: 29385923.
2. Kolber M, Wong C, Fedorak R, Rowe B. Prospective Study of the Quality of Colonoscopies Performed by Primary Care Physicians: The Alberta Primary Care Endoscopy (APC-Endo) Study. PLoS One. 2013; 8(6): e67017. doi: 10.1371/journal.pone.0067017. PMID: 23826186. PMCID: PMC3695091.
3. Grines C, Box L, Mamas M, Abbott A, Blankenship C, Carr J, Curzen N, Kent W, Khatib Y, Matteau A, Rymer J, Schreiber T, Velagapudi P, Vidovich M, Waldo S, Seto A. SCAI Expert Consensus Statement on Percutaneous Coronary Intervention Without On-Site Surgical Backup. J Am Coll Cardiol Intv. 2023 Apr, 16 (7) 847–860. https://doi.org/10.1016/j.jcin.2022.12.016
4. Wilkins T, LeClair B, Smolkin M, Davies K, Thomas A, Taylor M, Strayer S. Screening Colonoscopies by Primary Care Physicians: A Meta-Analysis. Ann Fam Med. 2009 Jan; 7(1): 56-62. doi: 10.1370/afm.939. PMID: 19139450. PMCID: PMC2625839
5. Moher D, Liberati A, Tetzlaff J, Altman D; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009 Jul 21;6(7):e1000097. doi: 10.1371/journal.pmed.1000097. Epub 2009 Jul 21. PMID: 19621072; PMCID: PMC2707599.

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