Essential tremor can be a debilitating disease. In many cases, medical treatment is ineffective and/or holds significant side effects. Surgical treatment using deep brain stimulation is only possible in few and selected cases. The introduction of MR-guided focused ultrasound enables surgeons to make small and specific lesions in the thalamus with few side effects and limited risk for the patient. The effectiveness has been documented in several international studies and is summarised in this review.