A number of newspapers and television stations have recently reported on the news of smog surgery. The discussion section of our published paper is posted below. This article was published in the Chinese Journal of Cerebrovascular Disease, Vol. 4, No. 10 (October 2007), and the cover photo is a photo of my surgery. If you are interested, you can check it yourself on the Internet and feel free to correct me. 1, clinical characteristics: Smoke disease is found all over the world, but it is most common in East Asia, especially in Japan, China and Korea. It is estimated that the annual incidence rate in Japan is 0.1/100,000, and the ratio of male to female is 1:1.6. The ratio of male to female in this group is 1:1.25. There is no large-scale survey data in China, but the detection rate has increased significantly in recent years. The disease can be seen at any age, and there are two peaks in the age of onset: the first peak is within 10 years of age, with ischemic attacks being the main cause and fewer hemorrhages; the second peak is between 30 and 40 years of age, with cerebral hemorrhages being more common. However, it is not uncommon for adults to have ischemic attacks. Most of the cases in this group are adult cases, and the ischemic onset is more common. The mortality rate of smog is about 7.5%, 10% in adults and 4.3% in children, and the main causes of death are hemorrhage and massive cerebral infarction. Therefore, once the diagnosis of smog is confirmed, surgery should be performed as soon as possible. Suzuki et al. classified the cerebral angiographic manifestations of smog disease into six stages according to the degree of stenosis of the internal carotid artery. The most commonly used clinical staging criteria are those of Matsushima (1990). In this group of cases, the above criteria were used for grading and sexing. 2.Surgery for smog disease can be divided into direct and indirect revascularization surgery. Direct revascularization 1. superficial temporal artery-medial cerebral artery branch anastomosis, the most commonly used; 2. occipital artery-medial cerebral artery branch anastomosis; 3. occipital artery-posterior cerebral artery anastomosis. Direct revascularization can immediately improve the ischemia of the brain. In patients with smoker’s disease, the cortical vessels become thin and the surgical operation is more difficult. 2.Indirect revascularization 1.Brain-dural-arteriosynovascular fusion (encephaloduroarteriosynangiosis, EDAS); 2.Brain-muscle vascular fusion (encephalomyosynangiosis, EMS); 3.Brain-muscle-arteriosynovascular fusion ( encephalomyoarteriosynangiosis, EMAS); 4, brain-dura-arteriomyosynangiosis (encephaloduroarteriomyosynangiosis, EDAMS); 5, circular saw bore, dural and arachnoid dissection; 6, large omental graft. In the nomenclature of surgical methods 1~4 above, “brain” refers to the recipient as cerebral cortex and soft meningeal vessels, “dura” refers to the vascular donor as the overturned dural artery, “muscle” refers to “muscle” refers to the deep temporal artery of the deep temporal muscle as the donor, and “artery” refers to the free and unobstructed superficial temporal artery. According to the above nomenclature, the indirect surgery part of this group can be named encephaloduromyosynangiosis (EDMS), which is different from EDAS, EMS, EDAMS and other procedures and has not been reported in the literature. In terms of the choice of donor vessels for indirect surgery, the experience of Huashan Hospital based on the postoperative follow-up angiograms of different procedures was that the deep temporal artery and the middle meningeal artery caused significantly better postoperative neovascular anastomosis than the superficial temporal artery, which had poor results as a donor vessel for indirect surgery, but the superficial temporal artery was the best donor vessel for direct surgery. Therefore, our surgical method has the following advantages: 1. First, it ensures the maximum use of the middle meningeal artery and its branches and the deep temporal artery as the donor vessels for indirect surgery; after finding a suitable recipient artery, the superficial temporal artery is freed to perform direct surgery of appropriate length, which can avoid unnecessary operations and save surgical time. 2. The shape of the bone flap allows us to preserve the integrity of the middle meningeal artery and to affix most of the temporalis muscle to the brain surface. 3. The complete deep temporal artery network is preserved during surgery, maximizing the role of the temporalis muscle in forming spontaneous anastomoses with the cortex. 4. Make full use of the blood-rich middle meningeal artery and its main branches, without destroying the distal dural-cortical artery anastomosis already formed in stage 5 and 6 patients. The dura is flipped and applied to the cortical surface, allowing the spontaneous anastomosis to extend beyond the bone window. 5. The superficial temporal artery has poor results in indirect surgery, so it is used as a direct anastomosis, which can immediately improve cerebral blood flow. 6. The lower part of the bone flap was appropriately raised outward so that the lower part of the flap did not compress the superficial temporal artery and temporalis muscle, eliminating the temporalis muscle-induced dominant effect and related postoperative complications. In conclusion, the surgical approach of this group can be named as superficial temporal artery-medial cerebral artery branch (STA-MCA) anastomosis combined with “encephaloduromyosynangiosis” (EDMS). The direct anastomosis of the superficial temporal artery to the middle cerebral artery immediately improves cerebral blood flow and maximizes the use of the middle meningeal artery and deep temporal artery as vascular donors for the indirect procedure, allowing the patient to continue to benefit from the new spontaneous anastomosis caused by the indirect procedure at a later time. This procedure combines the advantages of both direct and indirect surgery and is effective in improving ischemic symptoms in adults with smoldering disease, while its efficacy in preventing rebleeding in patients with hemorrhagic disease remains to be determined at long-term follow-up.