Many parents have this question: Does pediatric syringomyelia require surgery? When is the best time to have surgery? To answer these questions, one needs to know some basic knowledge about syringomyelia. During the descent of the testicle from the abdominal cavity to the scrotum, there is an expansion of the peritoneum at the front (i.e., the sphincter). Normally, the sphincter is closed from the internal inguinal ring to the top of the scrotum, with only a small potential cavity surrounding the testicle. If the embryo develops abnormally it can cause a pathological condition of the sphincter in the inguinal canal and scrotum, and a syringomyelia can develop. There are several types of syringomyelia, which can be divided into testicular syringomyelia and spermatic cord syringomyelia according to the location of the fluid. It is divided into simple syringomyelia and traffic syringomyelia according to whether it is connected to the abdominal cavity. Simple syringomyelia is formed by the accumulation of fluid in the sphincter cavity and will basically subside within 1 year of age. Therefore, most children with simple testicular syringomyelia at birth can be observed first. Aspiration is contraindicated during the observation period because it may lead to infection. The typical presentation of a communicating syringomyelia is that the size of the fluid usually changes with activity, being smaller in the early morning and gradually becoming larger after daytime activity. The diagnosis of a communicating syringomyelia can be made by history and physical examination. A communicating syringomyelia is diagnosed if the cyst can be compressed and the fluid within the cyst can be pushed back into the abdominal cavity. In most cases, simple syringomyelia can be differentiated from traffic syringomyelia by observation. The observations of the child’s parents or his caregivers can help in the diagnosis to the physician. If the syringomyelia is not large and the tension is not high, surgery may be unnecessary, especially in infants under 1.5 years of age, as it has a chance of resolving on its own. If the tension is high, it may affect the blood circulation of the testis and lead to testicular atrophy or traffic syringomyelia should be treated surgically.