Smoker’s disease is a rare cerebrovascular disease that is primarily a result of narrowing or occlusion of the cerebral arteries, which subsequently leads to the formation of an abnormal network of small malformed blood vessels at the base of the skull. To treat smog, surgery is generally considered necessary, as this vascular malformation is generally unlikely to be cured with medical medication. Some people ask whether surgery for smog must be performed cranially. But of course, the lesions of smog are all intracranial. The stenosis and occlusion of the major arteries are all intracranial, that is, the siphon section of the internal carotid artery, the anterior cerebral artery, the middle cerebral artery, and sometimes the beginning of the posterior cerebral artery, which are all intracranial; and the network of malformed vessels in smog is distributed at the base of the skull, which is also intracranial. To perform surgery to change these lesions, they must also be performed intracranially. Therefore, surgery for smoldering disease is necessary to open the skull, whether it is a traditional simple direct bypass surgery or a traditional patching surgery, it must be performed intracranially. Diagram of combined vascular bypass surgery Of course, although it is open cranial surgery, there is no need to worry unduly about concerns. The treatment of smoker’s disease has evolved over more than half a century, and craniotomy has been refined and improved over decades, and is now very mature and not very risky. For example, the combined vascular bypass surgery that we are now performing, although it is craniotomy, is very, very safe. Whether we do direct vascular bypass or some vascular regenerative tissue patching, although it is performed inside the skull, it is performed outside the brain tissue, and it does not cause any damage to the brain tissue. Moreover, we have a very complete surgical management system, including pre-operative management, intra-operative monitoring, post-operative care, etc. The whole perioperative period has a strict safety guarantee, so craniotomy is not terrible.