Background: Fluid management in neurosurgical patients is critical and important during the perioperative period. Electrical cardiometry (EC) is a new noninvasive technique for measuring cardiac output (COP). EC works based on the application of a high frequency transthoracic current and the analysis of variations of voltage in each heartbeat. The aim of this work is to compare the fluid management of intracranial surgeries using EC routine parameters. Methods: This is a prospective randomized, double-blinded controlled study was carried out on 70 patients of both genders aged > 21 years old, ASA physical status II or III, GCS 15 scheduled for elective craniotomy. Patients were divided into two equal groups at random; group A: standard management, group B: EC guided management. The primary outcome was the duration of intensive care unit (ICU) stay. Results: The ICU and hospital stay duration were significantly decreased in group B compared to group A. The mean total amount of infused volume of crystalloid solutions was significantly decreased in group B compared to group A. Hemodynamics, and number of patients received colloid, blood, vasopressor, and inotropes were insignificantly different between both groups. There was a significant increase in optic nerve sheath diameter in group A compared to group B at PACU and 24 h. Adverse events were comparable between both groups except encephalodema, which was significantly higher in group A. Conclusions: EC is an effective tool in COP measurement and a novel guide for fluid therapy as EC guided fluid therapy group was significantly decreased in ICU and hospital stay duration and the total amount of crystalloid with fewer adverse events.