Depending on the cause of the spinal cord cavitation, surgery is usually required. Spinal cord cavitation associated with cerebellar tonsillar herniation is treated by decompression of the posterior cranial fossa, which usually includes suboccipital explantation, superior cervical laminectomy and dural graft replacement. Minimally invasive surgery developed in recent years applies minimally invasive instruments with small incisions (about 4-6 cm in length) and small bone windows (2×3 cm in size) to perform various operations within the dura mater with the assistance of a microscope, such as separating the adhesions between the cerebellar tonsils and the brainstem and relieving the obstruction of the middle foramen of the fourth ventricle. There is less possibility of damaging the surrounding important structures during the operation, reducing the risk of surgery. If the outflow from the fourth ventricle is obstructed, the flow outlet can be enlarged and reconstructed. If the cavity is large, direct decompression of the fluid cavity has been recommended. Decompression surgery of the distended cavity may provide transient symptomatic relief, but the additional benefit of this procedure is uncertain, and the condition may recur after surgery. For Chiari malformation hydrocephalus should be eliminated first before cavitation surgery; the results are usually excellent and the neuropathy can be stabilized and restored in most cases. Post-traumatic spinal cord cavitation that causes progressive worsening of neurological symptoms or unbearable pain requires surgical management, such as various drainage procedures of the intramedullary cavity, myelotomy, and surgical spinal herniation formation. Root pain and sensory disturbances can usually be improved after surgery, but the results for spasticity are less satisfactory. The management of spinal cord cavitation caused by intramedullary spinal cord tumors is mainly resection of the tumor, and cystic decompression can only provide transient relief of symptoms.