3-D Tractography FUS Ablation for Essential Tremor

Inclusion Criteria: * Diagnosis of moderate to severe ET agreed upon by at least two movement disorder trained physicians * Symptoms refractory to at least two medications * Stable medication regimen for at least 4 weeks prior to screening * Willing and able to participate in all follow-up visits * Willing and able to undergo MR imaging. Exclusion Criteria: * Uncontrolled hypertension * Medically unstable coronary artery disease * Coagulopathy, anticoagulant therapy, or inability to temporarily stop any antithrombotic medication * Tremor disorders other than ET * Unwilling or unable to undergo tremor surgery while awake * Significant and non-correctible motion artifact in imaging * Pregnant at the time of enrollment or preoperative evaluation * Dementia * History of psychosis * History of drug or alcohol abuse * Prior brain surgery such as Vim-FUSA, deep brain stimulation, and gamma knife thalamotomy * Botulinum toxin injection in the tremor-impacted areas three months prior to the baseline assessment and until 3-months after Vim-FUSA * Skull density ratio lower than 0.4 * Does not qualify for FDA-approved clinical use based on current FDA labeling * Any significant issue raised by the neurologist or neurosurgeon that may compromise participant safety or potentially interfere with study interpretation.