How do we FUS? Peri-procedural management of magnetic resonance-guided focused ultrasound: An EMEA regional survey

Background: Magnetic resonance-guided focused ultrasound (MRgFUS) is an established incisionless treatment for essential tremor (ET), Parkinson's disease (PD) and neuropathic pain. Although efficacy and safety are supported by randomised trials and large series, peri-procedural management remains non-standardised. Methods: We conducted a structured, web-based survey of 41 centres performing MRgFUS for neurological indications across Europe, Middle East, and Africa (EMEA) region. The 35-item questionnaire covered four domains: centre activity and indications, discharge policy and reimbursement, use of corticosteroids and other medications, and team composition. Responses were anonymised and analysed descriptively. Results: Twenty-seven respondents (28 MRgFUS centres, 68% coverage) answered the questionnaire. Caseloads varied widely, from <50 to >400 cumulative procedures, with ET treated in all centres and PD in 70%. Discharge practice ranged from same-day to >48-h admission, and reimbursement was by national health system in 77.8%, mixed in 7.4%, and borne by patient/insurance in 14.8% of centres. Corticosteroids were used routinely in 63.0% of centres, selectively in 29.6%, and never in 7.4%, with marked heterogeneity in timing and tapering. Analgesics and antiemetics were routinely prescribed in 66.7% and 70.4% of centres, respectively. Sedatives or anaesthetic agents were rarely used, mirroring variability in anaesthesiologist involvement. A dedicated nurse in the MRI suite was reported by 63.0% of centres. Conclusions: Peri-procedural MRgFUS management is highly heterogeneous across EMEA centres, particularly regarding corticosteroid protocols and anaesthesiologist support. Future consensus work and prospective, registry-based studies will address these issues and define evidence-based, harmonised care pathways.