Superficial Temporal Artery to Middle Cerebral Artery (STA-MCA) bypass: How I do it.

The superficial temporal artery-middle cerebral artery (STA-MCA) bypass remains a key extracranial-intracranial revascularization technique for moyamoya disease, complex aneurysms, and symptomatic steno-occlusive pathology not amenable to endovascular treatment. Effective bypass requires detailed knowledge of STA and MCA anatomy, comprehensive preoperative imaging, and meticulous microsurgical planning. We describe a stepwise operative strategy including donor and recipient vessel preparation, microanastomosis, and intraoperative patency assessment. Technical nuances, complication avoidance, and postoperative management are emphasized. This report outlines essential principles for safe and durable STA-MCA bypass revascularization.