Background: Intraoperative ultrasound provides a low cost real time imaging that is quick and simple to use. In recent years there has been a significant improvement in the quality of ultrasound imaging. Ultrasound integrated neuronavigation can be used to optimize the lesion approach and achieve a safe maximal resection, thereby improving the outcomes of the patients with different localizations and histologic types of brain tumors, vascular pathology, spontaneous intracerebral hemorrhage. Material and methods: From 2007 to 2010 in the Institute of Neurology and Neurosurgery 130 operations with the application of 2D intraoperative ultrasound (US) were performed. From March to May 2012 17 patients underwent a surgical treatment with the usage the intraoperative ultrasound integrated neuronavigation system. Results: We have applied ultrasound neuronavigation system in 17 cases on the patients with diverse pathologies, including brain tumors(craniopharyngeoma, corpus collosum and intracerebral glioblastoma, intraaxial glioma), vascular pathology (arteriovenous malformations, aneurysms), spontaneous intracerebral hemorrhage. The application of ultrasound neuronavigation system helps in improving the postoperative outcomes of these patients. Conclusions: The integration of 3D US with neuronavigation technology has created an efficient and inexpensive tool for intraoperative imaging in neurosurgery. The technology has been applied to optimize the surgery of brain tumors, but it has also been found useful in other procedures, such as operations for aneurysms or arteriovenous malformations. Intraoperative ultrasound is easy to use and has a rapid assessment curve which makes it a useful tool of the neurosurgeons’ intraoperative armamentarium.