17 Liu, Jinlong Krauss, Jonas Purrer, Veronika Borger, Valeri Essler, Markus Radbruch, Alexander Wüllner, Ullrich Upadhyay, Neeraj Boecker, Henning AG Boecker Clinical Research (Bonn) AG Radbruch AG Wüllner Patient Studies (Bonn) Neurotherapeutics Neurotherapeutics Elsevier B.V. [Amsterdam] 1933-7213 10.1016/j.neurot.2026.e00864 English e00864 2 23 Magnetic resonance-guided focused ultrasound (MRgFUS) is a promising, noninvasive therapeutic approach for essential tremor (ET), yet the effects of the respective lesions on functional brain network organization remain poorly understood. Here, we performed graph theory analysis to investigate changes in small-world properties and modular architecture in ET patients six months after unilateral MRgFUS of the thalamic ventral intermediate (VIM) nucleus. Small-worldness and normalized clustering coefficient increased significantly after MRgFUS, while clustering coefficient, characteristic path length, normalized characteristic path length, global efficiency, and local efficiency remained unchanged. Modular organization was largely preserved, but trend-level enhancements in inter-modular connectivity were observed between frontoparietal and subcortical modules, as well as between frontoparietal and frontotemporal-parietal modules. Within these modules, betweenness centrality increased significantly in specific cortical hubs, including the left superior frontal gyrus, right superior parietal lobule, and left postcentral gyrus. These findings indicate that unilateral VIM-MRgFUS induces selective functional network reorganization, particularly affecting relative clustering and nodal centrality patterns. PUB:(DE-HGF)16, ; 0, ; Humans Essential Tremor: diagnostic imaging Essential Tremor: therapy Essential Tremor: physiopathology Essential Tremor: surgery Male Female Magnetic Resonance Imaging: methods Middle Aged Aged Ventral Thalamic Nuclei: diagnostic imaging Ventral Thalamic Nuclei: surgery Nerve Net: diagnostic imaging Brain networks Essential tremor Graph theory analysis MRgFUS Ventral intermediate nucleus Journal Article 2026 DZNE-2026-00361 2026 pmc:PMC12993401 pmid:41764014 https://pub.dzne.de/record/285915 https://doi.org/10.1016/j.neurot.2026.e00864