The evolution of extracranial-intracranial bypass surgery has depended on advances in technology to improve surgical techniques and perioperative care. As technology continues to improve, new adjuncts in the modern era further facilitate operative technique and allow for improved postoperative monitoring of complications. Three such notable advances are augmented reality with operative microscope, usage of exoscope, and ultrasound monitoring of graft through a sonolucent cranioplasty. Augmented reality allows for direct anatomical mapping overlaid on the surgical field through a now familiar operative adjunct—the surgical microscope. The exoscope offers improved surgical visibility and ergonomics. Sonolucent cranioplasty implant allows for a wealth of measurements in the immediate postoperative period and for long-term follow-up. Ultrasound monitoring allows for safe, real-time, efficient monitoring without exposing patients to ionizing radiation. It can be used to guide operative intervention for postoperative complications and for long-term follow-up.