Objective To explore the effect of a care protocol based on dynamic management of intracranial pressure (ICP) using transorbital sonography (TOS) in post-craniotomy patients.Methods A total of 120 post-craniotomy patients were randomly assigned to one of two groups, with 60 in each.The control group received conventional postoperative nursing care, while the intervention group received care guided by dynamic measurements of ICP using TOS.The care protocol was developed through literature review and expert consultation.The National Institutes of Health Stroke Scale (NIHSS) scores and the Glasgow Coma Scale (GCS) scores at transfer out of the ICU, the incidence of postoperative cerebral edema, acute kidney injury, and electrolyte disturbances (hyponatremia, hypokalemia, hypocalcemia), as well as length of ICU stay and hospital stay were compared between the two groups.Results The NIHSS score at transfer out of the ICU was significantly lower, whereas the GCS score was significantly higher in the intervention group compared with the control group （both P＜0.05）.The incidence of electrolyte disturbances, length of ICU stay, and hospital stay in the intervention group were significantly lower/shorter than those in the control group （all P＜0.05）.Conclusion The care protocol based on dynamic management of ICP using TOS is scientific and feasible, and can effectively improve neurological function of post-craniotomy patients, reduce the incidence of complications, and shorten the length of hospitalization.