Abstract: Dexmedetomidine is a highly selective α₂-adrenergic receptor agonist that mediates a synergistic sedative-analgesic mechanism by activating the locus coeruleus and spinal α₂-adrenergic receptors. It effectively reduces sympathetic nervous system excitability during the perioperative period, maintaining hemodynamic stability. The multiple pharmacological properties of dexmedetomidine demonstrate significant advantages in neurosurgical perioperative anesthesia management. Preoperatively, it effectively alleviates patient anxiety and enhances the efficacy of local anesthetics. Intraoperatively, it reduces secondary brain injury by inhibiting the inflammatory cascade and oxidative stress response induced by surgical trauma, and it helps decrease the use of opioids and general anesthetics. Postoperatively, dexmedetomidine effectively prevents agitation, delirium, and cognitive dysfunction during the recovery phase. By inducing a "wakeable sedation" state, it provides unique anesthetic and sedative conditions for intraoperative neurophysiological monitoring and awake functional area surgery, making it an ideal sedative for functional neurosurgery. This review systematically summarizes the basic and clinical research progress of dexmedetomidine in neurosurgical perioperative applications, aiming to provide a theoretical basis for optimizing perioperative anesthesia strategies in neurosurgery.