Superficial temporal artery to superior cerebellar artery bypass: how I do it

Superficial temporal artery (STA) to superior cerebellar artery (SCA) bypass is a deep and demanding posterior circulation revascularisation procedure. We describe our step-by-step technique through a subtemporal approach, illustrated with intraoperative images and schematic drawings, emphasising flattening of the middle fossa floor, mobilisation of the vein of Labbé, tentorial division, protection of the trochlear nerve, and shallowing of the anastomotic field. Together these nuances reduce the retraction force required, protect the trochlear nerve, and facilitate suturing within a deep and narrow corridor.