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

## TL;DR

This paper explains the step-by-step surgical technique for a specific brain bypass procedure used to treat complex brain conditions.

## Contribution

The paper introduces a detailed and systematic approach to performing STA-MCA bypass surgery with a focus on technical nuances and safety.

## Key findings

- A stepwise operative strategy for STA-MCA bypass is described with an emphasis on vessel preparation and microanastomosis.
- Intraoperative patency assessment and meticulous planning are highlighted as essential for successful outcomes.
- Technical nuances and postoperative management are emphasized to avoid complications.

## Abstract

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.

The online version contains supplementary material available at 10.1007/s00701-026-06799-2.