The patient a Syrian citizen came to the clinic 23-September-2004 in wheelchair. His brother telling that he had convulsions since birth with delayed milestones. At 15 years ago start to show scoliotic deformity of the occipito-cervical junction. He could walk 3 years ago. MRI of the brain performed 01-May-2004 was normal, but cervical showed huge intraspinal mass extending from C2 down to D3.

On examination: there is hypalgesia from the right V2 down to whole body. The right upper limb power is 0/5, the left deltoid 2/5, left biceps 5/5. grip and extension left hand 4/5, left triceps 3/5. The power of the lower limbs 3/5. All deep reflexes are exaggerated with all pathologic reflexes more the right side with clonus.

The patient was sent for investigations and MRI brain and cervical spine were repeated the next day showing progression of the intraspinal cervical mass.

Laminectomy C2 down to D2. The dura was opened and inspection of the spinal cord showed multi-compartment syrinx. The most transparent points were fenestrated and a tube was inserted to the syrinx cavity to communicate with the subarachnoid space. Strict hemostasis, routine closure of the wound. He was sent to the ward.

The patient came to the clinic 30-December-2004 with clean wound with new MRI done the same day showing shrinkage of the syrinx and the tube is in place. Normal micturition and defecation with better breathing and the power of the left upper limb and distal muscles of both feet normalized. The power of the right upper limb and proximal muscles of the lower limbs improved to several extent. The hypalgesia regressed to both upper limbs down to the left D4.

The syrinx is part of his pathology. Decompression and shunting is the best solution in this case.