Eighteen autopsy cases of syringomyelia were studied neuropathologically. In six cases associated with Chiari II malformation, the central canal was patent from the fourth ventricle to the syrinx, and the syrinx was simply a dilated central canal. In four cases associated with Chiari I malformation, the syrinx was irregularly shaped and communicated with the subarachnoid space at the entry zone of the posterior nerve roots. In six cases associated with spinal cord or posterior fossa tumors, the syrinx was located adjacent to the tumor tissues, and occupied the medullary gray matter or the spinal intermediate zone and the ventral part of the posterior horn. With regard to the pathogenesis of syringomyelia, we concluded that in cases associated with Chiari II malformation, vermian protrusion and direct continuity between the fourth ventricle and the syrinx were essential. In cases associated with Chiari I malformation, in addition to tonsillar protrusion, communication between the syrinx and the subarachnoid space was thought to play an important role, and in cases associated with tumors, the circulatory disturbance due to the presence of the tumors caused the syrinx.