Abstract:Revascularization of the vertebrobasilar territory is indicated for the management of carefully selected patients with refractory vertebrobasilar insufficiency, and complex unclippable aneurysms of the posterior circulation. Successful results depend on careful patient selection, choice of the appropriate bypass procedure for each individual patient, meticulous surgical technique, and optimal pre and postoperative management. The following revascularization procedures are described: external carotid artery (ECA)-to-posterior cerebral artery (PCA) saphenous vein interposition graft; superficial temporal artery (STA)-to-superior cerebellar artery (SCA) bypass; occipital artery (OA)-to-anterior inferior cerebellar artery (AICA) bypass; OA-to-posterior inferior cerebellar artery (PICA) bypass; PICA-PICA anastomosis; and vertebral artery microendarterectomy.