Smoker’s disease is a syndrome of abnormal vascular network formation at the base of the brain. Patients with smog have 2 manifestations: ischemia and hemorrhage. Cerebral revascularization is an effective treatment for smog. Patients with smoker’s disease presenting with clinical symptoms of ischemia and cerebral ischemia with cerebral perfusion deprivation on PET or cerebral blood flow with stage 2 hemodynamics on SPECT are indications for cerebral revascularization. In order to prevent rebleeding in hemorrhagic smog, cerebral revascularization surgery should be performed even if the cerebral blood flow reserve is not reduced. 1.Direct cerebral revascularization surgery Yasargil first performed superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery in 1970 to treat smog, and it has been widely used to treat ischemic smog since then, but in children, it is difficult to perform direct vascular bypass surgery because the main branches of MCA in cerebral cortex are small. After direct intracranial and extracranial vascular bypass surgery, blood flow from the extracranial arteries is supplied directly to the brain tissue in the ischemic area, which can immediately increase cerebral blood flow and improve cerebral ischemic symptoms. After STA-MCA anastomosis, the MCA blood supply can be supplied to the anterior cerebral artery (ACA) supply area through the collateral circulation established by the soft meninges, so it is not always necessary to perform STA-ACA anastomosis again, and its application is only in patients with significant ischemic symptoms in the ACA supply area. This medical history is less frequent. The posterior cerebral artery (PCA) can be involved in up to 25-60% of patients with smoker’s disease. These patients are at high risk for ischemic stroke because the PCA is an important collateral circulation pathway to the internal carotid artery in patients with smoky disease. In this case, STA, occipital artery (OA), and posterior cerebral artery (PCA) bypass surgery should be performed. 2.Indirect cerebral revascularization surgery Indirect bypass surgery includes cerebral temporal muscle patching, cerebral temporal muscle vascular connection, cerebral dural vascular connection, cerebral capillary tendon osteochondral connection, and cranial multiple drilling. The tissue supplied by the extracranial artery is used as the donor and is applied to the surface of the brain in the ischemic area to establish collateral branches. The risk of ischemic stroke during the perioperative period is higher than that of direct bypass surgery, but the operation technique is simple and safe. The perioperative complications are 4% for indirect bypass and 2% for direct bypass. Indirect bypass surgery establishes good collateral circulation in 100% of children, while 40%-50% of adults do not establish collateral circulation. Surgical complications of indirect bypass: adhesions of the temporalis muscle to the brain tissue and induced seizures. Microneurosurgical reconstruction is effective in the treatment of ischemic smoker’s disease, reducing the frequency of TIA episodes and decreasing the risk of cerebral infarction in patients. Indirect revascularization procedures are not as effective as direct bypass surgery in adults. However, in children, both direct and indirect bypass surgery can improve the prognosis.