How I do it: superficial temporal artery to middle cerebral artery bypass for moyamoya disease

Moyamoya disease (MMD) is a chronic progressive disease leading to recurrent stroke due to occlusion of the terminal internal carotid arteries. Surgical revascularization for symptomatic MMD is an effective treatment for preventing further stroke. However, direct revascularization of advanced MMD remains challenging due to small caliber of the recipient vessel and perforators.We introduce our technique of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass with figures and video to illustrate the procedure.Surgical nuances of STA to MCA anastomosis will help cerebrovascular neurosurgeons to master low-flow bypass for MMD.