This article extensively reviews the history, indications for bypass, choice of grafts, techniques, complications, and results after cerebral revascularization. The current role and future perspectives of cerebral revascularization are discussed. The results of 295 direct revascularization procedures in 285 patients (130 tumors and 115 aneurysms from 1988 to 2006; 40 cases of ischemia from 1994 to 2006) and 26 pial synangiosis procedures (for moyamoya syndrome in children from 1997 to 2007) have been summarized. Current operative techniques are illustrated with drawings and video clips.