脑绕道手术是神经外科中最复杂和最优雅的手术之一。它涉及几个细致的步骤，即使是准备最充分的神经外科医生也面临着考验。这项手术超越了其在动脉狭窄和动脉粥样硬化中的传统作用，将其应用范围扩大到包括针对动脉瘤、肿瘤和血管畸形等复杂病症的血流保存技术。许多医院进行的手术数量减少反映了新型血管内疗法的发展，但也是由于颅外-颅内搭桥研究、颈动脉闭塞手术研究以及颈动脉和大脑中动脉闭塞手术研究的结果，这些研究已提出了脑绕道手术对于易患缺血性中风的颈动脉闭塞患者的疗效的疑问。尽管如此，对于难以接受药物治疗的血流动力学损伤患者来说，搭桥手术仍然具有潜在的益处。此外，烟雾病血管病的血运重建是预防儿童和成人缺血性和出血性事件的有效策略。此外，流量调节旁路和术中流量评估等技术创新旨在最大限度地减少围手术期发病率。尽管当今时代进行的搭桥手术较少，但仍然鼓励未来的神经外科医生教授和发展这些技能，因为在可预见的未来，搭桥手术将继续发挥作用。

Cerebral bypass surgery is one of the most complex and elegant procedures in neurosurgery. It involves several meticulous steps that test the skills of even the most prepared neurosurgeons. This surgery has transcended its traditional role in arterial stenosis and atherosclerosis, expanding its applications to include flow preservation techniques for complex conditions such as aneurysms, tumors, and vascular malformations. The decreased number of procedures performed across many hospitals reflects the development of newer endovascular therapies but is also due to the results of the extracranial-intracranial bypass study, the Carotid Occlusion Surgery Study, and the Carotid and Middle Cerebral Artery Occlusion Surgery Study, which have raised questions about the efficacy of cerebral bypass surgery for individuals with carotid artery occlusion who are prone to ischemic stroke. Despite this, there is still a potential benefit of bypass surgery for patients with hemodynamic impairment refractory to medical management. Also, revascularization in moyamoya vasculopathy is an effective strategy for preventing ischemic and hemorrhagic events in both children and adults. Additionally, innovations in the technique, such as the flow-regulated bypass and intraoperative flow assessment, aim to minimize perioperative morbidity. Despite bypass surgery being less performed in this current era, the teaching and development of these skills are still encouraged for future neurosurgeons, as a role for bypass will exist for the foreseeable future.