Background: Awake craniotomy is a surgical technique that allows optimal tumor resection in eloquent brain areas, using real- ime patient feedback. There is no consensus about the best anaesthetic procedure; monitored an aesthesia care (MAC) is one of established protocol. Clinical case-series: Since recent implementation (2013), we’ve performed awake craniotomy in five patients (age 43-64 yrs; 2M, 3F). All of them were ASA II and have brain tumor in motor area. Patient were carefully selected by neurosurgeons, anaesthesiologist, neurologist and psychologist. According to MAC, patients were sedated and remained to breath spontaneously during the procedure. They recived premedication - midazolam and anticonvulsant. Routine monitoring in the OR included ECG, invasive and non- invasive BP, SpO2, RR, capnography, bispectral index and urinary output. We used target controlled infusion pumps for fine titration of remifentanil (Ce 0.5-3 ng/ml) and propofol (Ce 0.5-2 mcg/ml). For local infiltration at the site of pin insertion and skin incision mixture of bupivacaine 0.5% and lidocaine 2% with adrenalin 1:200.000 was used. Patients were respiratory and hemodynamic stabile during the procedure and cooperative for motor and language testing. Discussion: Modern anaesthetic approach in awake craniotomy is moving toward awake-awake-awake technique (2). We have chosen MAC as a technique that stands in between asleep-awake-asleep and awake-awake-awake technique because it is most suitable for our clinical practice. Our results are in concordance with more experienced centers: combination of local infiltration and MAC ensures patient satisfaction (as evaluated by psychologist) and stability with optimal intraoperative monitoring and working conditions for neurosurgeons.