Two days after admission, the patient underwent surgery to treat his Arnold-Chiari type I malformation and drain his intramedullary abscess. During treatment, he underwent posterior cervical laminectomy from C2 to C6-C7, myelotomy with microscope and CO2, drainage of the intramedullary abscess, duraplasty of the Arnold-Chiari type I malformation and cervical cord, drain placement, and intraoperative somatosensory evoked potentials and free-run electromyography. A midline incision was made from the spinous process of C1-C2 down to C7. The lamina from C2 to C7 was then subsequently removed. The dura was opened, and the exposed cord was observed to be extremely vascularized, with the cerebrospinal fluid appearing infected. A midline myelotomy was performed from C4 to C6, opening the syrinx, and the purulent material was evacuated with significant irrigation. Then the dura and the dural canals were closed, and a drain was placed.