One of the challenges in the management of advanced Parkinson’s disease is the occurrence of motor fluctuations and dyskinesias in response to antiparkinsonian medications. MR-guided focused ultrasound ablation (MRgFUS), which involves noninvasive, externally applied sonication energy, allows for ablative brain surgery without the need for craniotomy and is a method for the creation of very focused brain lesion that is potentially safer than radiofrequency surgery. Clinical trials have confirmed the efficacy of focused ultrasound MRgFUS-thalamotomy in essential tremor, which has recently been approved for unilateral treatment by the FDA. Unilateral treatment of the pallidothalamic tract (PTT), subthalamic nucleus, and globus pallidus has also been described for improving movement disorders.