Van Gerwen had to come from 4-2 down to see off De Sousa and produced a clinical deciding leg just as the Portuguese ace saw his scoring drop off.
The revival started with a 112 checkout to hold and make it 4-3 and it was soon parity with De Sousa way back as Van Gerwen hit an 11-darter to break and took control.
He went one away with a 79 checkout on double 11 and after De Sousa missed darts to force a decider, it was MVG's turn as he missed a dart for the win.
But he left 47 after nine taking it out in clinical fashion for the win.
Tournament Centre 2023 Belgian Darts Open: Schedule of play, results, TV Guide and prize money breakdown
Clemens came back from 5-2 down to edge through 6-5 with a 103.2 average with some rare form on the European Tour.
Wright missed a match dart from 71 and Clemens picked his pocket in the decider on double 18. A late call-up this weekend due to injury for Cameron Menzies and one he has made good on.