Patient Question: Disease: Spermatic syringomyelia Description: Dear Dr. Lu, Hello. Thank you for answering this question in your busy schedule. My baby boy, born in March 2011, was found to have similar fluid in his left testicle when he was two years old in 2013, and he went to Xinhua Hospital for examination and BC, saying it was a spermatic cord sheath effusion on the left side. Please see the uploaded report for details. Help wanted: Please ask the following points. Lu Liansheng, Department of Urology, Fudan University Pediatric Hospital 1, I heard that if there is a small amount of fluid, you can skip the surgery. I don’t know if we have to do surgery in this case of our baby. 2, if the surgery is done, it can be done before the age of a few years at the latest (because the child is young and still developing, so I want to do it as late as possible.) Is there any risk of surgery. 3. If the surgery is not done, which aspect of the child’s development will be affected, and whether the effect is probable or inevitable. Thank you very much! Reply: Hello! This question concerns the best time to treat pediatric syringomyelia and the choice of treatment plan. 1. There are no rigorous randomized controlled trial studies on the timing of treatment of pediatric syringomyelia. It is generally believed that most patients with pediatric syringomyelia will have their syringomyelia close on their own at the age of 1 to 2 years, and it is highly unlikely that syringomyelia older than 2 years will heal on its own. Therefore, the International Society for Pediatric Lumpectomy Clinical Guidelines recommend that children older than 2 years with congenital syringomyelia, persistently increasing intrasyringomyelia, or at risk of complicating inguinal hernia should be treated surgically. Of course, mild syringomyelia can also tend to be conservative and observed for a longer period of time. 2. Treatment options: Since most pediatric syringomyelia are traffic-related and the sphincter is not closed, a high sphincter ligation is preferred for pediatric syringomyelia, which is completely different from the syringomyelia reversal surgery used for adult syringomyelia. For syringomyelia high ligation, we currently perform both open surgery and minimally invasive laparoscopic surgery. In pediatric patients, there is a high incidence of contralateral syringomyelia, and laparoscopic surgery allows for intraoperative exploration and treatment of the contralateral syringomyelia at the same time, avoiding the need for reoperation. In contrast, traditional open surgery cannot detect the contralateral sphincter. 3. Any surgery has risks. Pediatric syringomyelia surgery is relatively simple, with little risk and a high success rate. If surgery is not done, there are some children whose syringomyelia will continue to increase or be complicated by inguinal hernia, which will have clinical discomfort and may affect testicular development in severe cases.