Moyamoya disease is a rare chronic cerebrovascular disease. Its imaging features are progressive stenosis and occlusion of the terminal internal carotid artery and compensatory capillary collateral circulation. Cerebral revascularization is currently the best treatment for moyamoya disease. Its goal is to reduce the incidence of stroke, improve symptoms, improve the quality of life by improving cerebral blood flow and restoring cerebral vascular reserve by providing collateral pathways. This article will review the epidemiology, etiology, clinical symptoms, treatment, and anesthesia management of moyamoya disease to provide an update on current trends. This article focuses on the principles of safe and balanced anesthesia during cerebral revascularization, including maintaining a more stable individual hemodynamics, ensuring adequate cerebral perfusion, normal intracranial pressure, optimizing the balance of cerebral oxygen supply and demand to prevent intraoperative cerebral ischemia. Perioperative anesthesia management directly affects the length of hospital stay and long-term neurological outcome of patients with moyamoya disease, so it is a great challenge for anesthesiologists.