Pediatric Neurosurgery is a complex subspecialty. The pathology is so diverse and the patients so fragile. We have tried to illustrate common as well as the more rare pathological conditions that afflict the pediatric population. I learned much from my attendings and senior residents, but each case was yet again so different that I wished there was some text that would describe the thought processes and management for these patients. This way I would be more prepared to understand the patient's disease and speak to the patient and family with more experience and specifics. Thus, we have decided to write this text for the senior and junior residents as well as the medical students. We delve into defining the differential diagnoses for a variety of intracranial and spinal pathology. We go through the thought processes in treating and managing such patients. We have real cases with full high definition pictures. This is a culmination of over 6 years of patient care in pediatric neurosurgery.