Congenital neurosurgical problems are by definition, present at birth, although they may not become symptomatic, or be detected until sometime later. Pediatric neurosurgeons deal with a variety of congenital problems, including spina bifida, tethered cord, Chiari malformations, hydrocephalus, arachnoid cysts, and craniosynostosis, often in conjunction with other specialists. Close follow up of these patients is essential, and may be required throughout the patient's lifetime. In the past, it was thought that children with congenital neurological issues would inevitably decline, and die. Through the work of a number of dedicated pediatric neurosurgeons, this idea has been refuted, and the present view is that decline is not the natural history of these patients, and any clinical deterioration should be investigated, and potentially may be treated.