Ultrasound imaging has become a common method for evaluation of the central nervous system. In this report, we present our novel experience with ultrasonography monitoring conducted through a burr-hole for investigation of intracranial lesions. A portable ultrasound scanner and a small transducer with a straight, untapered head were used. After opening a standard burr-hole, the transducer was inserted through the burr-hole and the intracranial lesion was examined. Intraoperative ultrasonography provides immediate ongoing information about the anatomy and pathological lesions. Distance and trajectory to the best location for the catheter were determined and the catheter was inserted with ultrasound monitoring. The final position of the catheter placed accurately into the intended compartment of the ventricular system. No procedure related complication was noted and pitfalls were minimal. Furthermore, a postoperative CT scan was obtained in each case to confirm the appropriateness of the procedure with ultrasonography. In conclusion, intraoperative ultrasonography using a burr-hole transducer has proved useful in neurological surgery.