Awake craniotomy is a surgical operation in which a bone flap is temporarily removed from the skull to access the brain and done when person is awake. Awake craniotomy has been reported to minimize both intensive care time and total hospital stay .Awake craniotomy was performed as patients were positioned in a supine or lateral position with rigid head fixation after administration of a local anesthetic (1% xylocaine with epinephrine and 0.75% anapain) at the pin sites and regional field block sites then oxygen was administered through a mask, and cortical mapping was performed by stimulating the cortex with a modified Ojemann stimulator. To avoid inducing intraoperative seizures, a low-stimulus setting (3-5mA, 60-Hz biphasic square wave pulse of 1 ms/phase for 4 s) was used .The tumor was removed in the usual fashion. Present Study included 110 (59 men and 51 women) patients who underwent craniotomy in regions suspected preoperatively of containing supratentorial brain tumor. Another 15(7 men and 8 women) patients underwent craniotomy under general anesthesia of same regions. Plasma levels of adrenaline were significantly higher in awake craniotomy than in craniotomy under general anesthesia during surgery, while plasma levels of cortisol, ACTH and noradrenaline were significantly higher in craniotomy under general anesthesia than those in awake craniotomy just after surgery.

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