High-grade gliomas (HGGs), marked by their aggressive behavior and considerable morbidity, present a considerable challenge in the field of neuro-oncology.1 The central aspects of management often revolve around surgical resection, prioritizing the achievement of gross total resection (GTR) and also includes maximal safe tumor removal when feasible, along with adjuvant chemoradiotherapy adhering to protocols such as the Stupp protocol, which is recognized as a standard of care in both Europe and the United States, since several resections of HGG are performed primarily for debulking purposes due to the eloquence of the tumor and the preoperative functional status of the patient.2 However, achieving GTR is a complex endeavor, with factors such as tumor location, infiltrative growth, and proximity to eloquent brain regions significantly influencing surgical outcomes.3 Researchers continuously explore novel techniques to enhance the rate of GTR, seeking advancements that can significantly impact patient prognosis and quality of life.

In the quest for refining HGG resection, intraoperative ultrasonography (iUSG) has emerged as a valuable tool offering real-time imaging guidance during surgery. Integrating iUSG into neurosurgical procedures allows for enhanced visualization of tumor margins and surrounding structures, aiding neurosurgeons in making informed decisions during the delicate resection process.4 The ability to dynamically assess tumor boundaries and adjust surgical strategies in response to evolving anatomical considerations (even though surgery is ongoing) positions iUSG as a promising adjunctive technique in HGG surgery.5

Against this backdrop, this meta-analysis endeavors to systematically evaluate and synthesize the existing body of literature on the use of iUSG in guiding the resection of HGG. By pooling data from available studies, the aim is to provide a comprehensive overview of the impact of iUSG on the attainment of gross total resection in HGG and the impact on complications related to resection.