Smoker’s disease is a relatively rare cerebrovascular disease that was first identified by Japanese scholars in the 1950s and 1960s. Smoker’s disease is a chronic progressive narrowing or occlusion of the major branches of the cerebral arterial ring bilaterally (the end of the internal carotid artery, the anterior cerebral artery, the middle cerebral artery, and sometimes the beginning of the posterior cerebral artery), followed by the formation of an abnormal vascular network at the base of the skull. This abnormal network of vessels at the base of the skull appears as a cloud of small vessels resembling smoke on cerebral angiography, hence the name smog. There are two major age peaks for the onset of smog, one in adults around 40 years of age and the other in children under 10 years of age. So what tests do children have to know if they have smog? The tests for smog include CT angiography, MRI, cerebral angiography, etc. Cerebral angiography is the gold standard for diagnosing smog. If the diagnosis of smog is confirmed, prompt surgical treatment is required. A 5-year-old girl from Shandong Province, Xiao Han, developed weakness in her limbs and fell several times while playing in the park. After many inquiries, the parents brought their child to us for consultation. After a detailed scientific diagnosis and evaluation, the team performed a combined vascular bypass surgery and cured the child’s disease. Xiao Han’s limb weakness was significantly relieved and his mental state greatly improved, and he was successfully discharged from the hospital about 10 days after the surgery. At present, the medical profession basically recognizes that conservative medical treatment for smog is of little significance, and that smog should be treated surgically as soon as it is diagnosed. Combined vascular bypass surgery is a very effective means of treating smog. The combined bypass surgery is different from the traditional direct bypass surgery or patching surgery, but the direct bypass surgery and patching surgery are done together in one surgery, and the direct bypass surgery can rapidly improve the local blood supply in the cranium, and at the same time, the multi-factor patching on the brain surface can induce the formation of neovascularization and improve the cerebral blood vessels to a larger extent, and achieve good results.