Purpose: To determine whether weight fluctuations significantly affect the formation and resolution of syringes associated with Chiari 1 malformations. Methodology: We present a unique case of remarkable improvement of a cervical syrinx after weight loss from bariatric surgery and discuss the underlying pathophysiological principles. This novel demonstration posits that non-operative management and aggressive weight loss strategies in a carefully selected subgroup of overweight patients with a syrinx may obviate the need for surgery and its attendant risks. This is the first reported case of cervical syrinx resolution following weight loss assisted by bariatric surgery. A literature review of all relevant cases associating weight change and syrinx stability was conducted. Results: Obesity exacerbates the pressure gradient which precipitates syrinx formation given the disproportionately raised intrathoracic and intraabdominal pressure. This is transmitted via the valveless vertebral venous compartments to the spinal subarachnoid space in turn and drives the increase in syrinx size. This theoretical pathophysiological principle was shown to rationally translate into clinical and radiological outcomes in our unique case of syrinx resolution following weight loss. Conclusion: In asymptomatic obese patients with a Chiari I Malformation associated with a cervical syrinx, it may be reasonable to trial a period of conservative management with aggressive weight loss strategies including bariatric surgery. Conversely, overweight patients who have a known Chairi 1 Malformation should be counselled on the importance of further weight gain and potential syrinx formation. Further prospective large multi-centre randomized trials are still required to validate our observations.