Background: Recovery from neuroanesthesia requires stable hemodynamics and optimal cerebral oxygenation. Objective: The purpose of this study was to compare the effect of low dose sugammadex with neostigmine on recovery and cerebral hemodynamic profile after supratentorial tumor resection. Patients and Methods: In this double-blind randomized study, forty patients were allocated according to the reversal used after supratentorial tumor surgery into, sugammadex 2 mg·kg^–1 (group S) or neostigmine 0.05 mg·kg^–1 + atropine 0.02 mg·kg^–1 (group N). Duration from reversal to train of four 0.9 was a primary outcome. Arterial and jugular bulb blood samples obtained after induction, before closure of dura, before reversal, ten minutes after reversal then one hourly for 3 hours postoperative for the calculation of arterial-jugular oxygen content difference “CaO₂-jO₂," cerebral oxygen extraction “CEO₂", jugular venous oxygen saturation (SjvO₂), estimated cerebral metabolic rate “eCMRO₂," and cerebral blood flow equivalent “CBFe," as secondary outcomes. Results: We demonstrated that recovery time (duration from reversal to train of four 0.9) was significantly shorter with sugammadex (P=0.001). Sugammadex recorded significant increased CEO₂ and CaO₂-jO₂ at 10 minutes after reversal, at 1 hour (hr), 2 hr and 3 hr postoperatively. Sugammadex resulted in significant decreased SjvO₂ and CBFe at 10 minutes after reversal, at 1 hr, 2 hr and 3 hr postoperatively without significant effect on eCMRO₂. Conclusion: Low dose sugammadex (2 mg.kg^-1) provided rapid and effective reversal of rocuronium NMB superior to neostigmine with improved cerebral hemodynamic profile after supratentorial tumor surgery.