Moyamoya disease (MMD) is a group of occlusive disorders characterized by spontaneous progressive stenosis and occlusion of the internal carotid arteries and Willis rings bilaterally above the bed process of unknown etiology and the presence of numerous collateral compensatory vessels at the base of the skull. In contrast, other confirmed symptoms leading to the above manifestations are called Moyamoya syndrome. Clinical presentation: more than half of adult patients have intracranial hemorrhage as the first symptom; children tend to have TIA and cerebral infarction as the main manifestation. Preoperative examination routine: DSA whole brain angiography is performed to clarify the diagnosis. All 6 vessels (bilateral internal carotid arteries, bilateral vertebral arteries, bilateral external carotid arteries) must be done during angiography to understand the compensation of side branches and to provide reference for surgery. Treatment: Drug therapy has no definite efficacy so far. At present, surgery has become the gold standard of MMD treatment. Surgical principle: choose the more severe ischemic side for surgery. If the bilateral ischemia is similar, the dominant hemisphere is chosen first. For patients with bleeding type, the bleeding side is chosen. Surgery can effectively reduce the incidence of stroke and transient ischemic attack (TIA) in it. The indications for surgery in Japanese MMD guidelines are: recurrent clinical symptoms due to cerebral ischemia that interfere with work; reduced local blood flow to the brain, compensatory volume depression, and diminished vascular responsiveness. There is no consensus on the bleeding type of MMD. Most experts consider that most of the hematoma is absorbed, the neurological function is still recoverable, and the basic life can still take care of itself as the indications for performing revascularization. The technique: based on revascularization, there are three types: direct vascular bypass, indirect vascular bypass and combined vascular bypass.1 Direct vascular bypass is technically difficult and has a high chance of postoperative complications of hemorrhage, with the advantage of improving cerebral perfusion rapidly and effectively. Disadvantage: single vessel anastomosis may not be able to lift moyamoya disease multiple vessel occlusion.2. Indirect vessel bypass is relatively simple and has a short intraoperative operation time, but the formation of collateral circulation is slow or even cannot be completely formed, and the effect of improving cerebral perfusion is poor. Indirect: Various blood supply tissues including dura mater, temporalis muscle and superficial temporal artery are applied to the surface of the brain, as well as incision of the arachnoid membrane to induce neovascularization. Disadvantages: 1. If extra-cranial-intracranial circulation is found to be established in the intended surgical area, they may be destroyed by skin, bone or dural flaps. 2. Failure to improve the blood supply to the anterior cerebral artery may be helped by multiple cranial borings. 3. Superficial temporal artery-middle cerebral artery bypass combined with temporalis muscle patching (STA-MCA-EMS).