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Background: The superficial temporal artery to middle cerebral artery bypass remains the favoured direct technique of cerebral revascularization in moyamoya angiopathy. We describe a novel technique of tunnelling the superficial temporal artery through the temporalis muscle.

Methods: The temporalis muscle is raised as a flap off the temporal bone. A triangular window is created on the temporalis fascia, and a tunnel is created for the superficial temporal artery to pass through the muscle belly.

Conclusion: This innovative technique allows passage of the superficial temporal artery to the brain without kink or compression ensuring good bypass function and improves long-term patency.

Keywords: Moyamoya; Temporalis; Tunnelling.