Contrast-enhanced ultrasound (CEUS) is a real-time, feasible technique. Both intraoperatively and bedside, it satisfies the need for serial assessment and easy performability. Initially employed in neuro-oncology, it has recently overcome this first application. The chapter aims to give a comprehensive view of its use in oncological, vascular, and spinal neurosurgery. CEUS versatility across the aforementioned areas is analyzed, underlining its complementarity to other well-settled imaging techniques. Its major oncological (both cerebral and spinal) and vascular (including aneurysms, AVMs, dAVFs, carotid plaques, and stroke) application and state of the art are discussed. The chapter is focused on reporting CEUS advantages and disadvantages, giving an insight to future perspectives and applications.