The use of preoperative imaging in neurosurgery is essential for safe and reliable surgical planning. Computed tomography and magnetic resonance imaging allow visualization of intracranial pathology; however, it is crucial to complement them with intraoperative techniques. This is particularly important when there is a possibility that the size of the lesion may vary or that the anatomy may change after the initial imaging, due to the rapid progression of intracranial diseases. In this context, intraoperative ultrasound (iUS) emerges as a valuable tool, providing real-time images that allow surgeons to monitor the procedure, facilitate the placement of drains or catheters, and assess the residual volume of tumors or hematomas during surgery.To evaluate the effectiveness of intraoperative ultrasound in different neurosurgical scenarios, relevant studies from databases such as SciELO, PubMed, Cochrane, and Google Scholar were reviewed, and these findings were compared with the results from our own series of patients in whom intraoperative ultrasound was applied. The sample included 118 patients of various ages, genders, and diagnoses, operated on at Ridge Hospital by the Neurosurgery Service between December 1, 2021, and September 30, 2023. Hydrocephalus and intraparenchymal hematomas were the most frequent diagnoses. No complications related to the use of ultrasound were recorded, and improvements in surgical outcomes were observed.Thus, intraoperative ultrasound is reaffirmed as an effective tool in modern neurosurgery, increasing precision and reducing complications. Although the technique has certain limitations, its accessibility and versatility make it an indispensable option in most neurosurgical settings.