Intracranial and extracranial cerebral revascularization for smog and other cerebral ischemic diseases In the past decade or so, with the improvement of clinical imaging means, smog and stroke caused by severe cerebral vascular stenosis or occlusion have been recognized by more and more neurological surgeons. After years of research, clinicians at all levels at home and abroad have concluded that performing intracranial and extracranial cerebral revascularization surgery is an effective method to achieve radical cure. Smoldering disease, also known as anomalous network of cerebral base vessels, is a chronic, progressive obstructive disease characterized by bilateral occlusion of the internal carotid arteries and the formation of an abnormally thin, smoke-like network of vessels at the base of the skull. The pathogenesis of smoldering disease is still unknown, and epidemiological studies have found that the disease is associated with genetics, head and neck infections, trauma, and radiation therapy. The clinical manifestations of this disease are mainly cerebral ischemia and cerebral hemorrhage, and its onset mainly threatens children and adolescents around the age of 10 and the prime of life around the age of 40, which is obviously different from atherosclerotic ischemic cerebrovascular disease that mainly threatens middle-aged and elderly people. Due to the low diagnosis and treatment rate of this disease in China 10 years ago, it had been treated as a rare cerebrovascular disease. In recent years, this recognition is gradually changing. With the widespread use of cerebral angiography (DSA), MRA, and CT angiography (CTA), the number of diagnostic cases of smog disease has increased significantly. According to the statistics of the Hospital of the Academy of Military Medical Sciences, which has the highest number of smog cases in China, Henan, especially our city, is a national high incidence area for smog, so it is socially important to improve the diagnosis and treatment rate of smog for stroke prevention and treatment. The symptoms of smog disease are complex, mainly manifesting as headache, epilepsy, sudden numbness and weakness of limbs, abnormal sensation, loss of reading, aphasia, blurred vision, hemiplegia, hemianopia, mental retardation and vision changes, etc. In severe cases, the disease starts with cerebral infarction or cerebral hemorrhage, which is life-threatening. At present, the treatment of smog disease mainly adopts surgical intracranial and extracranial blood flow reconstruction to relieve the inadequate blood supply of intracerebral arteries, increase the blood supply of brain tissue in the operated area, and reduce the smoggy vessels, so that the clinical symptoms can be relieved or disappeared. Blood flow reconstruction is similar to the “South-North Water Transfer” project, which improves the blood flow in the brain and reduces the risk of cerebral ischemia and cerebral hemorrhage by establishing a pathway for blood supply from the normal blood vessels outside the brain to the brain. Intracranial and extracranial blood flow reconstruction surgery includes direct blood flow reconstruction (intracranial and extracranial vascular bypass) and indirect blood flow reconstruction (cerebral-dural-arterial vascular fusion (EDAS), multi-point drilling, temporalis muscle patch and dural reversal, etc.) and comprehensive surgical treatment, of which comprehensive surgical treatment is the combined application of two surgical methods, which is an advanced treatment plan in the world today. Both methods can be performed. Indirect revascularization (cerebral-dural-arterial vascularization (EDAS), is a procedure in which tissues rich in extracranial blood supply are applied to the brain, while dural reversal is performed using the rich blood supply of the dura mater. 3-4 months later, the blood vessels on these tissues will spontaneously anastomose with the cerebral cortex vessels, thus providing additional blood supply to the brain. Studies have confirmed that about a week after this approach, branches of the ipsilateral superficial temporal artery may have begun to participate in the blood supply to the brain and begin to influence cortical blood flow, resulting in clinical improvement in the patient. Direct bypass surgery is based on skilled microvascular manipulation, using the superficial temporal artery or occipital artery to perform direct anastomosis with cortical vessels to ensure immediate blood supply to the ischemic brain region with patency, resolving cerebral ischemia and improving cerebral hemodynamic damage. At present, it is believed that bypass surgery is the only strategy to stop rebleeding. After direct bypass surgery, the smoke vessels are reduced or disappeared from angiography, because the tiny microvessels are the source of bleeding, thus reducing the occurrence of rebleeding. Surgical treatment experience: 1, according to the clinical and imaging data to select the appropriate cases, the development of surgical modality; 2, pay attention to the patient’s perioperative management, stabilization of blood pressure and internal environment; 3, vascular bypass grafters need to be skilled in the systematic training of animal vascular anastomosis, postoperative patency test, timely postoperative management of cerebral blood flow hyperperfusion; 4, the correct anesthetic treatment during surgery is an important method to prevent intraoperative ischemic complications 5. For direct reconstruction, anticoagulation therapy should be stopped 3 days before surgery and appropriate anticoagulation therapy should be performed 3 days after surgery, and dilation therapy should be performed as early as possible after indirect reconstruction; 6.