The development of high-intensity ultrasound technology into a system for performing image-guided noninvasive ultrasound neurosurgery has developed at a relatively rapid pace in the past few years. Magnetic resonance imaging has contributed significantly to this development by providing a modality by which percutaneous ultrasound treatments can be preoperatively planned, intraoperatively guided and postoperatively evaluated for safety and efficacy. Especially in the case of transcranial ultrasound therapies, the structural identification and thermal monitoring of cortical structures is essential to avoid overheating at the skull-brain interface and to avoid the sonication of critical structures. This chapter briefly describes the physics of transmitting ultrasound through the skull and the technological advances that circumvented the physical limits imposed by the skull bone. The integration of magnetic resonance guidance and monitoring is detailed, along with an overview of ongoing studies with a commercially developed magnetic resonance imaging-compatible hemispherical transducer array.