Intraoperative contrast-enhanced ultrasound (iCEUS) is a relatively new technique for visualizing brain gliomas and can help achieve maximum resection, but its potential in spinal cord gliomas evaluation has not yet been well defined. We aim to describe the iCEUS characterization of and evaluate its role in visualizing intramedullary gliomas.A retrospective review of patients who underwent intramedullary gliomas resection with iCEUS guidance from 2019 to 2021 was conducted. An offline analysis was performed to compare and characterize the perfusion features of each gliomas.Thirty-six patients who underwent iCEUS for spinal cord gliomas were included. iCEUS was performed successfully, and all gliomas were clearly identified. The contrast agent's distribution also showed different dynamic phases (arterial, peak, and washout) from those observed in the brain gliomas, generally appearing slower and less intense in spinal cord gliomas. iCEUS helped highlight the intramedullary gliomas, each of which demonstrated specific iCEUS features depending on the grade. Gross total resection (GTR) was achieved in 20 patients (55.6%), subtotal resection (STR) in 11 patients (30.6%), and partial resection (PR) in 5 patients (13.8%).ICEUS adds valuable information in highlighting spinal cord gliomas in real time and allows the neurosurgeon to assess the anatomical locations of the gliomas and delineate the tumor margins. iCEUS could play a potentially important role in guiding spinal cord gliomas resection. Further study with more cases is needed to better understand the microbubble distribution dynamics in intramedullary gliomas.Copyright © 2022. Published by Elsevier Inc.