I. Treatment 1. Internal treatment The main treatment is symptomatic. For ischemic initiation, vasodilators and anticoagulants can be applied. For cerebral hemorrhage patients apply hemostatic drugs and antifibrinolytic drugs, etc. For patients with epilepsy and involuntary movements it is appropriate to do the corresponding symptomatic treatment. Patients with cerebral hemorrhage with intracranial hypertension should have appropriate control of intracranial pressure. 2.Surgical treatment (1) Purpose: Before the irreversible neurological dysfunction of brain tissue occurs, increase the lateral branch circulation of brain through surgical methods, improve the blood supply of brain and restore normal neurological function. (2) Surgical method: It can be divided into direct and indirect revascularization surgery. (1) Direct revascularization surgery. ②Indirect revascularization surgery. (3) Choice of surgical method: It depends on the site and nature of cerebral ischemia and the surgeon’s preference for a certain surgical method. In general, direct revascularization can immediately supply blood to the ischemic hemisphere, but it is technically demanding and increases the difficulty of the procedure if the child has fine vessels. The advantages of the indirect method are the simplicity of the approach, the lack of effect on the collateral branches already attached to the arteries from the scalp and dura, and the lack of need for temporary blockage of cerebrovascular branches. Therefore, cerebral-dural-arterial-vascular fusion is preferable in pediatric patients, and is usually followed by symptomatic improvement of cerebral ischemia 4-20 days (mean 10 days) after surgery. This symptomatic improvement of cerebral ischemia is estimated to be the result of spontaneous traffic of intracranial and extracranial vessels generated by wound healing in the early stages. These neovascularization connects to the external carotid artery and, due to the pressure gradient, allows blood from the external carotid artery to flow into the internal carotid system, creating an initial, continuous blood supply. Two to three months after surgery, the dural artery thickens and cerebral blood flow increases at the surgical incision. When sufficient cerebral blood flow is established, the ischemic attack resolves on its own. Ischemic seizures generally disappear on average 239 days after surgery. If the disappearance of ischemic attack lasts for more than 6 months, it can be called ischemic attack discontinuation. (4) Timing of surgery: only half of patients with ischemic attack disappears within 4-5 years by internal treatment, and the rest of patients still have ischemic attack for 7 years. Ischemic episodes in smoker’s disease will last for a long time in the natural course of the disease, and the longer the course of the disease, the greater the impact on IQ. It has been reported that if IQ is set at 86 as normal, then 92% of patients with smoker’s disease have normal IQ within 4 years of onset, 40% of patients have normal IQ 5-9 years after onset, and only 33% of patients have normal IQ 10-15 years after onset. (5) Bilateral surgery problem: If the patient’s general condition is good, bilateral hemispheric revascularization can be performed in one anesthetic. If the surgery is staged, the hemispheres with the following conditions should be operated first: recurrent TIA, dominant hemisphere, and cerebral hemodynamic studies showing more severe reduction in cerebral blood flow and perfusion reserve. Surgery on the other side is usually performed at least 6 months after the first indirect surgery and the patient’s neurological symptoms and signs are stable. Prognosis The prognosis of this disease depends in most cases on the natural progression of the disease, that is, it is related to the age of onset, the primary cause, the severity of the disease, the degree of brain tissue damage, and other factors. Whether the treatment is timely and appropriate also has a certain impact on the prognosis. The prognosis is generally considered to be good, with a low mortality rate and few sequelae. The mortality rate is 1.5% in pediatric patients and 7.5% in adults. 30% of pediatric patients may be left with mental retardation, while adults with intracranial hemorrhage have a high mortality rate, but most of them do not have sequelae if the coma period is passed quickly. From the radiological point of view, the natural course of the disease is mostly from one to several years, and once the cerebral base artery ring is completely occluded, the development of the lesion stops when the collateral circulation has been established, therefore, the overall prognosis is still optimistic.