Dexmedetomidine (Dex), an α2 adrenergic agonist, provides sedation that resembles natural sleep, as well as analgesia and sympathetic neuronal activity inhibition without respiratory depression. Besides, patients are readily be arose. Monitoring of electrophysiological function of the brain during the functional neurosurgical procedure is crucial for localization of the operational brain region and the results of operation. Current reports indicate that a low dose of Dex does not interfere with electrophysiologic monitoring, which allows brain mapping during awake craniotomy and microelectrode recording (MER) during deep brain stimulation (DBS) surgery. This review summarizes the category of functional neurosurgery and key points of anesthetic management, the pharmacological properties of Dex, the advantages of Dex in functional neurosurgery, and related clinical research in recent studies to rationally use Dex to optimize anesthetic management and improve patients' prognosis.