Abstract Objective To investigate the surgical treatment of ischemic cerebrovascular disease caused by severe stenosis or occlusion of the middle cerebral artery. Methods Nine patients with ischemic cerebrovascular disease caused by severe stenosis or occlusion of the middle cerebral artery with symptoms underwent superficial temporal artery-middle cerebral artery anastomosis combined with cerebral-dural-muscular vascular fusion (combined cerebral blood supply artery reconstruction), and the symptoms, signs and changes of cerebral blood flow before and after the perioperative period and follow-up were analyzed. Results The surgery was successfully completed in the whole group of cases. Seven cases were followed up after surgery, with a follow-up period of 6 months to 24 months, averaging 12 months, and all symptoms improved or disappeared compared with those before surgery: the preoperative National Institutes of Health Stroke Scale (NIHSS) total score was 14 in seven patients, which decreased to 3 at follow-up, and the preoperative Modified Rankin Scale (MRS) total score was 13, which decreased to 4 at follow-up. Conclusions The results of combined cerebral supply artery reconstruction for severe middle cerebral artery stenosis or occlusion were largely satisfactory in patients with strict indications. CT perfusion is valuable as a cerebral blood flow assessment method for preoperative case screening and postoperative outcome assessment in patients with severe middle cerebral artery stenosis or occlusion.