Smoker’s disease (also known as skull base vascular anomaly) is a disease characterized by progressive stenosis or occlusion of the ends of the internal carotid arteries bilaterally and the formation of an abnormal vascular network at the distal end of the vessels at the skull base. The abnormal vascular network at the base of the skull has a “smoke-like” appearance on cerebral angiography, so it is also known as smoky disease. The cause of the disease is still unclear. There are two peak ages of onset, children and adults, and the clinical manifestations in children are symptoms related to cerebral ischemia, while adults show symptoms related to cerebral hemorrhage, with ventricular hemorrhage being the most common. The cerebrovascular changes in smoker’s disease are bilateral, while the unilateral changes are called “smoker’s syndrome”. Smoke disease is a chronic progressive ischemic cerebrovascular disease, and early treatment is recommended. The treatment of smoker’s disease is mainly neurosurgical microsurgery, which is divided into direct reconstruction (superficial temporal artery middle cerebral artery bypass) and indirect reconstruction (temporal muscle posting) or direct combined with indirect.