This systematic review aims to investigate the complications associated with HiFU for neurological disorders and determine their frequency and nature regarding the need for on-site neurosurgical intervention as a crucial step in expanding access through virtual platforms. 

High intensity focused ultrasound (HiFU) has emerged as an effective, incisionless treatment for various neurological conditions, including tremor, epilepsy, and obsessive-compulsive disorder. Despite its promise, uncertainty remains regarding whether any complications necessitate on-site neurosurgical intervention. Expanding HiFU to telemedicine could significantly enhance accessibility by allowing functional neurosurgeons to perform these procedures remotely. Similar transitions have occurred in other fields, where specialists have adopted traditionally surgical procedures, increasing access to care. For instance, telerobotic surgery has enabled remote interventions, particularly benefiting patients in rural areas.

A systematic literature search was conducted using PubMed/MEDLINE, Cochrane, and Scopus databases up to September 2024, adhering to PRISMA guidelines. Studies were included if they mentioned HiFU side effects in the context of neurological conditions. Of 10,221 studies screened, 369 underwent full-text review, and data was extracted from 111 studies that met predefined inclusion criteria.

The review found no reported side effects necessitating immediate or delayed neurosurgical intervention. Commonly reported side effects included headache, along with transient symptoms such as ataxia, dysarthria, paresthesia, sensory deficits, dysphasia, dysgeusia, weakness, scalp edema, sensations of tightness, cold, or warmth, facial paralysis, memory disturbances, dyskinesia, dysmetria, nausea, stomach pain, increased anxiety, pin site pain, MRI burns at frame pin sites, and gait disorders, all of which are manageable by non-neurosurgeon healthcare providers.

Given the absence of side effects requiring on-site neurosurgical intervention, this systematic review highlights the potential to transition HiFU procedures to be performed remotely by functional neurosurgeons via telemedicine, thus aiming to reduce barriers to care. However, further research is needed to fully assess the viability and safety of this expansion.