The parents of 2-year-old Doudou found that his right scrotum was larger than the left one after he was born, and they didn’t pay much attention to it at first, but as the child grew up, the right scrotum became larger and larger than the left one, and it also seemed swollen and could not subside, and the surface skin was red and tight, so the parents rushed to take Doudou to the hospital to see a doctor. After the pediatric surgeon’s diagnosis, Doudou was diagnosed with testicular syringomyelia, and he recovered from surgery and was discharged soon after. So what is syringomyelia? Does pediatric syringomyelia require surgery? When is the best time to have surgery? A pediatric syringomyelia is clinically similar to an inguinal hernia in that the mass is located in the groin and/or scrotum, but its contents are not intestinal but fluid, so it is called a syringomyelia. In early embryonic development, a protrusion is formed in the lower abdomen, which enters the groin and extends to the base of the scrotum to form a sheath. During the formation of the sheath, the testis is placed immediately dorsal to the sheath and enters the scrotum through the inguinal canal, which covers the spermatic cord and most of the testis dorsally. Under normal circumstances, the sphincter is first occluded from the inguinal ring before birth, and then closed by the sphincter in the upper part of the testis, and finally the entire spermatic cord is occluded and atrophied to form a fibrous cord, leaving only the testicular sheath with a gap, forming the intrinsic testicular sheath cavity, which is not accessible to the abdominal cavity, and there is often a small amount of fluid in the cavity, so that the testis has a certain sliding range in the sheath cavity. If there is an abnormality in the occlusion process of the syringomyelia, so that there is a different degree of communication between the testicular sheath cavity and the abdominal cavity, the fluid in the abdominal cavity accumulates at a certain level through the abnormal closure of the syringomyelia, which is clinically known as syringomyelia. Syringomyelia can be divided into testicular syringomyelia, spermatic cord syringomyelia, and spermatic cord testicular syringomyelia according to the location of the fluid accumulation; simple syringomyelia and communicating syringomyelia according to whether it communicates with the abdominal cavity. Simple syringomyelia is formed by the accumulation of fluid in the sphincter cavity and will basically subside within half a year of age. Therefore, for most children with simple testicular syringomyelia at birth, they can be observed first. Aspiration is contraindicated during observation because it may lead to hematoma and infection. The typical presentation of a traffic syringomyelia is that the size of the effusion usually changes with activity, being smaller in the early morning and gradually becoming larger after daytime activity. If the syringomyelia is not large and the tension is not high, surgery may be unnecessary, especially in infants less than half a year old, and most of them have the possibility of self-absorption and regression. If the tension of the syringomyelia is high, it may affect the blood circulation of the testes and lead to testicular atrophy, or traffic syringomyelia should be treated surgically. Surgical treatment should be considered for syringomyelia after the age of 6 months because the appropriate temperature of the testis is about 34°C, and the testicular temperature in children with syringomyelia is definitely higher than normal, thus affecting testicular development. Since the causes of pediatric syringomyelia are different from those of adults, parents are advised to visit a children’s hospital or a hospital with a specialty in pediatric surgery.