Abstract:Superficial temporal artery to middle cerebral artery revascularization has evolved as a method to treat selected patients with intracranial ischemia. Specific indications include nonatherosclerotic occlusive vascular disorders, symptomatic brain ischemia in patients with inaccessible atherosclerotic occlusive disease who have not responded to maximal medical therapy, carotid artery dissection or penetrating injuries, and as an adjunct for deliberate large vessel arterial occlusion after failure of temporary trial occlusion. Careful preoperative evaluation and meticulous attention to detail before surgery yield good patient outcomes with minimal adverse effects and few deaths. This study reviews the indications and operative techniques for superficial temporal artery to middle cerebral artery anastomosis, the most common extracranial to intracranial revascularization procedure.