Background Dexmedetomidine, a highly selective agonist of α2-adrenergic receptors, has many pharmacological properties, such as dose-dependent sedative, analgesic, stable hemodynamic, sympathetic inhibition, inhibition of stress response, no respiratory depression and so on. Therefore, its application has been increasing in the perioperative period of awake craniotomy. Objective To review the advances of the dexmedetomidine used in awake craniotomy. Content This article elaborates the anesthetic challenges, the specific application and related pharmacological properties of dexmedetomidine in awake craniotomy. Trend Dexmedetomidine has been proved to possess the unique advantages through the application in the perioperative of awake craniotomy, and will be widely used in the future.