Have you ever heard of smoke sickness? The 48-year-old Mr. Xu, who had been in good health, had a sudden headache for more than 3 hours one day last month, accompanied by vomiting 2 times. It turned out to be a rare “smoke disease” in the trouble. The patient underwent bypass surgery and clamping by Huang Lijin, director of our interventional department, to connect the blood vessel on the scalp to the blocked blood vessel in the brain, so that the blood vessel on the scalp can supply blood directly to the brain. After the surgery, Mr. Xu recovered well and was able to walk out of the hospital when he was rechecked. In the middle of last month, Mr. Xu was sent to the hospital after having severe head pain for more than 3 hours. Emergency CT showed subarachnoid hemorrhage, whole brain angiography showed tiny aneurysm of the left anterior communicating artery, while bilateral occlusion of M1 segment of middle cerebral artery and smoke-like vessel formation were found, confirming the diagnosis of smog combined with aneurysm. “The blood vessels in the brain are like the branches of a tree, and the blood from the main trunk reaches all parts of the brain through the branches, but the main trunk in the smog patient was blocked.” After the trunk is blocked, numerous capillaries grow to replace it, and from the angiogram, it looks like a cloud of smoke tangled in the brain, explained Huang Lijin, director of the interventional department at the Third Affiliated Hospital of Southern Medical University. Moyamoya disease, also known as Moyamoya disease, is a chronic progressive stenosis of the main branch vessels bilaterally in the ring of Willis, followed by the formation of an abnormal network of collateral vessels that resembles smoke. Moyamoya disease is rarely heard of, but not rare. Patients present mainly with cerebral ischemia, cerebral hemorrhage, epilepsy, and possibly other clinical manifestations, and cerebral hemorrhage and cerebral infarction can be interchanged. Director Rikin Huang, who has a long history of research on smog, said that in Asia, pediatric patients tend to present with ischemic clinical manifestations, while adults tend to present with hemorrhagic clinical manifestations. Smog can affect patients’ cognitive function, especially in the areas of intellectual memory, executive function, and quality of life, and according to the literature, it affects pediatric patients to a greater degree. Three days after Mr. Xu’s bleeding, Chief Huang Lijin and his physicians performed a left anterior communicating artery aneurysm clamping and a left superficial temporal artery-middle cerebral artery bypass combined with temporal muscle patching. Director Huang said that smog often combines with intracranial aneurysms due to altered hemodynamics. Once an aneurysm ruptures, it can be life-threatening. Combined aneurysms are usually treated with interventional embolization, but sometimes the aneurysm is too small or the aneurysm neck is too wide, and the only way to close the aneurysm is by craniotomy. If craniotomy is chosen, only aneurysm clamping is usually performed during the acute phase of hemorrhage because it is more difficult to perform aneurysm clamping and vascular bypass surgery at the same time. In this case, the patient underwent aneurysm clamping and vascular bypass surgery in the acute phase of hemorrhage, and two difficult surgeries were completed simultaneously in one anesthesia, which has not been reported at home and abroad. Finally, through the 8-hour operation, Mr. Xu was finally pushed back to the ward, and the review angiography showed that the anterior communicating aneurysm was well clamped and the bypass vessel was open, and he has been discharged with good recovery. The treatment of smog disease through bypass surgery is a difficult surgery in medicine, and the quality of survival of patients can be greatly improved after the surgery. Experts say that the incidence of smog is not low, if there is unexplained slurred speech, hand and foot movement disorders, frequent walking and falling or symptoms such as stroke, headache, etc., you should go to the hospital in time to check, and through MRI, cerebral angiography, etc. to confirm the diagnosis of smog.