Skull base tumors are often intimately involved with critical vascular structures, which can be a barrier to maximal resection. In these cases, cerebral revascularization, including vascular bypass, can be an important adjunct technique. The feasibility of bypass depends on patient history, the anticipated tumor pathology, and characteristics of the cerebral vasculature. These procedures require considerable experience and expertise, and their indications must be well considered before performing them. A number of imaging and interventional studies can help establish the utility and feasibility of bypass preoperatively. Emerging technologies will help to refine the indications and streamline the performance of these challenging procedures. Here, we discuss the historical basis of bypass in skull base tumor surgery, indications in the modern era, the microanatomy of common bypasses, patient selection, and endovascular options for revascularization.