Moyamoya diease (MMD), also known as spontaneous skull base arterial ring occlusion, is a compensatory abnormal network of blood vessels at the base of the skull due to progressive narrowing and occlusion of the internal carotid artery and its branches. The dilated vessels look like smoke on angiography, hence the name smoker’s disease. Clinical and experimental evidence suggests that the disease is a group of acquired occlusive cerebrovascular diseases with an immune vascular response and a consequent inflammatory response. The disease was first identified in Japan in 1961 and has been reported in various countries since then. Epidemiological investigations have found that MMD is highly prevalent in yellow ethnic groups in East Asia. There are two peak incidences of MMD, namely, 5-10 years and 35-45 years. In recent years, with the promotion of MRA and CTA noninvasive vascular examinations and the increasing awareness of smog among neurologists, the clinical detection rate of smog disease has increased significantly. In Japan, for example, the prevalence rate was 3.16 per 100,000 in 1995, but increased to 10.5 per 100,000 in 2008. The first symptom types of smog include TIA, cerebral infarction, epilepsy, headache and cerebral hemorrhage, and the actual pathogenesis is complex and variable and can be mixed. More than 90% of childhood smoky disease are ischemic attacks, which may present with varying degrees of hemiparesis, or left and right side paralysis, and may be accompanied by aphasia, choking and coughing, dysphagia, mental retardation, dementia, seizures, headache, and transient ischemic attacks. Smoke disease in children in China has close to 50% brain infarction rate, much higher than Japan and Korea, indicating that some early symptoms such as blurred vision, headache, numbness and twitching of limbs, and mental retardation are not given enough attention in China, resulting in late consultation. For asymptomatic patients with smog, prospective studies have found that the chance of stroke is 3.2%/person/year, while for patients with symptomatic smog, the rate of stroke within 5 years of onset is 65%, compared to 5.5%-17% in the surgical treatment group, which significantly reduces mortality and disability rates. In Japan, Europe, America and Korea, there is no doubt about the surgical treatment of smog. In the 2012 edition of the Japanese guidelines for the treatment of smog, it is clearly stated that surgical revascularization is effective for patients with smog who present with ischemic symptoms. Revascularization can improve cerebral blood flow, reduce the severity and frequency of ischemic injury, reduce the risk of cerebral infarction, and improve the postoperative quality of life and long-term prognosis of brain function. In children with predominantly ischemic forms of smog, surgery is also effective in protecting intellectual development. The aim of surgery in smog is to find a way to reduce or relieve cerebrovascular occlusion. There are two broad categories, direct and indirect, both of which aim to surgically perfuse the cerebral cortex with vascular fusion from the external carotid artery. Both direct and indirect anastomoses are effective in improving the prognosis of pediatric patients.