To date, foreign studies have shown that there are no effective drugs to treat smog. Usually used blood-activating drugs and other drugs can temporarily relieve cerebral ischemia, but cannot treat smog itself. Surgical revascularization can create bypass vessels and is the most effective treatment to improve cerebral hemodynamics and reduce the risk of stroke. Surgery for smog can be divided into three types: vascular bypass, patching, and combined bypass surgery (vascular bypass + patching). Vascular bypass surgery includes superficial temporal artery (STA) to middle cerebral artery bypass (STA-MCA) and, in some patients with severe ischemia in the anterior cerebral artery supply area, STA to a branch of the anterior cerebral artery (STA-ACA). The surgical procedure and technique are similar to those performed for carotid artery sclerosis or occlusive lesions. However, some pediatric cases are difficult to bypass because the cortical vessels in pediatric patients are very thin and brittle compared to adult patients. One of the advantages of bypass surgery is that it improves cerebral hemodynamics immediately after surgery and prevents the recurrence of cerebral infarction. However, patients must be carefully monitored and treated after bypass surgery because sudden and significant changes in cerebral blood flow after surgery may lead to hyperperfusion syndrome, especially in patients with severe preoperative cerebral ischemia. Pre- and postoperative SPECT examinations, as well as intraoperative blood flow monitoring, play an important role in identifying and avoiding serious complications due to postoperative hyperperfusion. There are several different approaches to patching: cerebral-dural vascularization (EDS), cerebral-temporalis muscle vascularization (EMS), cerebral-dural-arterial-temporalis muscle vascularization (EDAMS), and cranial drilling procedures. In these procedures, the superficial temporal artery, dura mater, temporalis muscle, and soft membrane tissue can be used as tipped donor tissue. The advantages of the patching procedure, which can induce neovascularization between the brain surface and the vascular donor tissue, are: first, the procedure is simple and can be easily extended to primary hospitals; second, multiple factors and a larger patching area can be done, allowing the effective scope of the procedure to be expanded. However, the disadvantages are also obvious: first, the effect of patching surgery does not appear immediately after surgery, and it takes 3-4 months to form bypass vessels, during which cerebral infarction or cerebral hemorrhage may still occur; second, different methods of patching surgery design will produce different effects, because the formation of bypass vessels after surgery is closely related to the scope of craniotomy, generally speaking, the larger the scope of surgery, the larger the formation of neovascularization Third, although almost all pediatric patients can form bypass vessels, about 40-50% of adult patients cannot form bypass vessels after the patching surgery, which means that these patients will not have better surgical results, so vascular bypass surgery is especially important for the treatment of adult patients with smoke. Combined bypass (vascular bypass + patching) surgery includes both vascular bypass and patching, which has the advantages of both of these surgical approaches. The incidence of perioperative cerebral infarction is lower with vascular bypass and combined bypass surgery than with patching surgery. A new combined bypass surgical approach has been explored at Hokkaido University Hospital in Japan to improve blood supply to a large area of the cerebral surface. In addition to the superficial temporal artery, dura mater and temporalis muscle, the frontal cranial periosteal flap of the frontotemporal craniotomy is also used as the donor tissue for the vascular connection of the patching procedure, which can cover a large area of the frontal cortex with a view to forming a neovascular bypass in the medial frontal lobe, and this procedure is called brain-dura-memporalis-artery-periosteal vascularization (EDMAPS). More than 100 procedures have been performed in their hospital over 10 years, performing single or two STA-MCA+EDMAPS procedures. Postoperative cerebral angiography and SPECT or PET scans showed extensive improvement in cerebral hemodynamics on the operated side, including frontal brain tissue. There were no further ischemic or hemorrhagic strokes after surgery. Studies of the STA-MCA+EDMAPS procedure over many years have found that it is one of the most efficacious methods available for the treatment of smog.