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This chapter presents a case study of a 60-year-old right-handed male with a WHO Grade II astrocytoma diagnosed and treated with gross total resection at that time. This case demonstrates some common adversities faced in epilepsy surgery during awake craniotomy. Gross total resection of the tumor was adequately achieved and the lesion was sent for frozen and permanent pathology. At this point, the patient was sedated and the wound was closed in the normal anatomic layers. The addition of dexmedetomidine to propofol decreases the amount of propofol needed for sedation and allows the maintenance of spontaneous respiration. The other benefit of dexmedetomidine is its inhibitory effect on hypercarbia-induced cerebral vasodilation and consequently intracranial hypertension. Patient education and a thorough discussion of the risks and benefits of such a procedure are important prior to surgical intervention being offered because of the potential complications that can be encountered during this procedure.