The authors analyzed the outcome of 21 patients who underwent 24 craniotomies with intravenous sedation and brain mapping for the resection of brain metastases by the senior author from July 1995 through July 2000. All patients had tumors in close proximity to eloquent cortex including speech and sensorimotor areas. There were no perioperative deaths. Of 21 patients with neurologic deficits, there was complete resolution in 67%, improvement in 14%, and no change in 14% after surgery. Only one patient with preoperative hemiparesis sustained permanent neurologic deficit. The median length of stay was 3 days. The authors found awake craniotomy to be a safe procedure in patients with metastases sited in eloquent brain, with a low complication rate. Local anesthesia obviates the complications of general anesthesia, minimizes the hospital stay, and allows brain mapping to be performed during tumor extirpation. Most patients tolerated the procedure well, and none required conversion to general anesthesia. This technique should be part of every neurosurgical oncologist's repertoire.