Awake craniotomy requires patients to remain partially conscious and cooperative while undergoing intracranial surgery, a state in which the auditory channel remains one of the few reliable routes for communication, reassurance, and emotional regulation. Evidence from auditory evoked potential studies, event-related potential research, and investigations in disorders of consciousness indicates that auditory processing persists, at least at a subcortical and often at a cortical level, across a wide range of arousal states, including sedation and general anesthesia. This persistence carries both risk, in the form of implicit distressing memories, and opportunity, in the form of therapeutic auditory input that can modulate autonomic tone, cortical arousal, and subjective experience. This review synthesizes neurophysiological literature on auditory processing under altered consciousness, the psychological burden associated with awake craniotomy, and the growing body of clinical evidence on music- and voice-based interventions in the perioperative setting. It then examines Quranic recitation as a culturally and spiritually salient auditory stimulus, drawing on electroencephalographic, autonomic, and endocrine studies that report increased alpha-band activity, reduced cortisol and adrenocorticotropic hormone levels, and lower self-reported anxiety among Muslim listeners across multiple clinical contexts. A conceptual neurophysiological model is proposed to explain how a semantically and emotionally meaningful auditory stimulus such as Quranic recitation could, in principle, be integrated into the auditory environment of awake craniotomy to support autonomic stability, reduce psychological distress, and preserve the cooperative state required for intraoperative brain mapping, while respecting the technical constraints of language and motor testing. Gaps in direct evidence, methodological limitations of the existing literature, and priorities for future controlled research are discussed.