Abstract:Cerebral revascularization procedures are designed to enhance cerebral blood flow (CBF) to prevent or treat cerebral ischemia. Although the microsurgical techniques for cerebral revascularization are mature, the precise indications for surgery in many clinical scenarios are in an evolutionary stage. There remains considerable controversy, for example, regarding the indications for cerebral revascularization in patients with internal carotid artery occlusions or in those with planned carotid sacrifice for skull base tumors or aneurysms. The authors review the clinical scenarios in which revascularization would be considered and discuss current concepts regarding the indications for revascularization procedures.