Background: Ultrasonography is an accessible imaging modality that provides real-time guidance with minimal risk or additional time. There is a strong correlation between ultrasonography and postoperative computed tomography when evaluating the extent of tumor resection, suggesting ultrasonography can have significant clinical implications. The objective of this study was to provide more evidence on the usage of ultrasonography in the determination of gross-total resection of brain tumors. Material and methods: This study consisted of a retrospective review of patients treated at the Institute of Neurology and Neurosurgery between 2015 and 2020 for a brain tumor. All patients were treated with ultrasonography and then underwent postoperative tomography with or without contrast within first 3 days after surgery. Results: A total of 85 cases were included. Ultrasonography results showed a strong association with postoperative tomography. Ultrasonography was able to accurately identify residual tumor in 100% of subtotal resection cases where resection was stopped due to invasion of tumor into eloquent locations. Cases involving gliomas had a 75% intended total resection rate. Cases involving metastatic tumors had an 87% intended total resection rate. The sensitivity and specificity were reported for ultrasonography in all included tumor pathologies, glioma cases, and metastatic tumor cases, respectively. Conclusions: The use of ultrasonography may allow for a reliable imaging modality to achieve a more successful total resection of brain tumors. When attempting total resection, it was demonstrated an 81% total resection rate. Ultrasonography can be used in brain tumor surgery to improve surgical outcomes.