Objectives: Our aim is to compare awake craniotomy using conscious sedation with asleep-awake-asleep technique using a laryngeal mask airway (LMA) for resection of supratentorial tumors encroaching on eloquent brain areas regarding anesthetic and neurological complications. Patients & Methods: Forty patients ASA I and II, aged 20-50 y harboring supratentorial tumors were included in this study. We excluded patients with confusion, extreme anxiety, morbid obesity, COPD, obstructive sleep apnea, complicated airway, end organ affection and history of allergy to local anesthetics or drugs used in the study. Surgeries done in non-supine position or lasting more than 5 hours were also excluded. Results: A better control of hemodynamics was observed in the AAA group. On average, the intraoperative mean arterial blood pressure and heart rate were 7% to 10% lower in the AAA group than the CS group and this difference was statistically significant (P < 0.05). Severe pain was encountered in 15% of the CS group versus 10% of the AAA group with no statistically significant difference between the groups (P = 0.63). The CS group had shorter mean operative time (231±16.5 min) than the AAA group (277±14.1 min). The mean difference was 46 minutes. Conclusion: conscious sedation technique for awake craniotomy is a relatively simple procedure that needs less time to perform and perhaps better achieves the goal of providing a smooth transition to alertness, and obviates the difficulties of airway intervention.