Intraoperative neurosonography was performed in 44 patients with contact transdural or transgyral scanning technique. Localization of intracranial pathology included primary brain tumors (24), metastatic tumors (11), aneurysms (two), abscesses (two), arteriovenous malformation (one), thrombosed arteriovenous malformations (two), and plasmacytoma (one). Sonographic guidance was used in transdural decompression of three cystic lesions, therapeutic and diagnostic aspiration of two abscesses, and biopsy of three solid lesions. The expertise of the physician-sonographer with sonographic equipment facilitates accurate and expedient intraoperative neurosurgical localization of pathology.