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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\u2013MCA bypass revascularization.<\/jats:p>","DOI":"10.1007\/s00701-026-06799-2","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:54:40Z","timestamp":1771332880000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Superficial Temporal Artery to Middle Cerebral Artery (STA-MCA) bypass: How I do it"],"prefix":"10.1007","volume":"168","author":[{"given":"Paolo","family":"Palmisciano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Vernile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudhakar","family":"Vadivelu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Zuccarello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"issue":"04","key":"6799_CR1","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1055\/s-0031-1280685","volume":"21","author":"N Andaluz","year":"2011","unstructured":"Andaluz N, Zuccarello M (2011) Treatment strategies for complex intracranial aneurysms: review of a 12-year experience at the University of Cincinnati. 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