Can you remember what I told you before the operation? Yes, you asked me to memorize a poem – “The moonlight before the bed, is suspected to be frost on the ground. Can you count? Yes, 1, 2, 3, 4, This is a case of intraoperative anesthesia with wake-up anesthesia for a patient with intracranial tumors undergoing resection of intracranial tumors in our Skull Base Oncology Surgery Department. Intraoperative wake-up anesthesia is an anesthetic technique that requires the patient to complete certain neurological tests and commands while awake at some point during the surgical procedure. The biggest advantage of this technique is that it can evaluate the patient’s neurological status during the operation, so that the patient can complete sensory, motor and neurocognitive tests while awake, which provides a reliable guarantee for the success of the operation. Surgical treatment of lesions in the functional areas of the brain is a difficult problem in neurosurgery, and the main contradiction in the surgical treatment of such lesions is the contradiction between the degree of resection of the lesion and the trade-off between the patient’s neurological function. By waking up the patient under general anesthesia during the operation and cooperating with the operation in the awake state, the intraoperative neuroanatomical and functional localization is carried out by using neuronavigation and neuroelectrophysiological techniques. Intraoperative real-time monitoring of possible brain functional area damage, maximizing the protection of brain function, is the current new strategy for brain functional area surgery. This method of anesthesia is a challenge for anesthesiologists: not only do they need to provide sufficient depth of hypnosis and analgesia during intense surgical stimulation, but they also need to awaken the patient quickly to cooperate with the surgery without respiratory depression when performing surgery in the functional projection area. Intraoperative arousal anesthesia techniques are mainly suitable for epilepsy, refractory movement disorders, refractory central pain, and tumors in functional brain regions; they are not suitable for patients with confusion or mental disorders, communication difficulties, excessive anxiety, low occipital tumors, and lesions with obvious adhesions to the dura mater, obesity, and poor respiratory function. Unskilled neurosurgeons and anesthesiologists should also not use this technique lightly. The implementation of intraoperative awakening anesthesia technique is carried out according to the following principles: 1. Make adequate preoperative preparations. Detect the blood concentration of therapeutic drugs and continue to use them until the day of surgery. Avoid the use of sedative drugs before surgery to minimize their effect on the electroencephalogram. The anesthesiologist should establish a good relationship with the patient, help the patient to be fully prepared psychologically, explain in detail the specific process of surgical anesthesia and possible discomforts, the ability to tolerate the surgical steps, and inform in detail the necessity and significance of the functional monitoring, the steps and requirements of the intraoperative monitoring, in order to obtain the cooperation of the patient.2. To carry out the preoperative assessment. One day before the surgery, the patient should be evaluated for speech function, graphic recognition function, evaluation of limb movement function, cognitive function, evaluation of behavioral changes during seizures, and anesthesia plan should be formulated. Anesthesia methods were monitored anesthesia (MAC), local anesthesia combined with needle anesthesia, and awakening anesthesia techniques (AAA). Intraoperative airway management is done to ensure an open airway. The use of intermittent command ventilation (SIMV) enhances respiratory management and reduces the incidence of hypercapnia. Intraoperative patients tolerate the airway device well when they are awake, and it is easy to remove or re-insert the airway device either in supine or lateral position. Operation Procedure: Understand the condition, communicate with the doctor in charge, familiarize with the surgical plan and process, fully grasp the patient’s general condition, and explain in detail the entire surgical anesthesia process to the patient and his/her family. It is also necessary to keep the patient’s valid contact information, and to do the survey of intraoperative knowledge after 3 months postoperatively. Through the intraoperative awakening anesthesia technique, our hospital has successfully removed intracranial tumors for 13 patients. These patients have recovered well after surgery, ensuring no damage to functional areas and also improving their quality of life.