Cerebral revascularization is used to augment or replace cerebral blood flow in patients at risk of developing cerebral ischemia. These include patients with moyamoya disease, occlusive cerebrovascular disease, skull base tumors, and complex aneurysms. Our aim in this review is to provide a comprehensive update of both surgical and anesthetic aspects of cerebral revascularization procedures. The anesthetic concerns for most patients presenting for different types of bypass procedures are similar and include the maintenance of adequate cerebral perfusion to prevent cerebral ischemia. Patients with complex aneurysms and tumors have additional considerations related to the surgical treatment of the underlying pathology.