Background: Awake Craniotomy during pregnancy is a rare but urgent procedure. Since pregnancy can both accelerate the progression of a tumor and mask other diagnoses, cases may lead to premature termination of pregnancy. From a neurosurgical, anesthetic, and obstetrical perspective, these operations may be challenging. Methods: In accordance with the PRISMA guidelines, MEDLINE, Scopus, and Web of Science databases were searched from inception to January 3rd, 2023. Studies were included if they included pregnant patients who underwent awake craniotomy. Results: Nine papers fit the criteria for the final analysis. All investigations were case studies. A total of nine patients were included. Mean age at surgery was 26.9 years, and mean gestational age at craniotomy was 20.9 weeks. Eight (88.9%) patients underwent craniotomy for tumor resection and the other had a pseudoaneurysm repair. Glioma was the most common tumor pathology (n=5), followed by meningioma (n=1), and glioblastoma (n=1). None of the patients experienced significant intraoperative or immediate postoperative complications. There were no obstetrical complications or significant changes in fetal status during or after surgery, and all reported deliveries were successful with healthy infants. Conclusions: Awake craniotomy during pregnancy can be a safe procedure with appropriate pre-operative patient selection and extensive multidisciplinary planning.