PROGNOSIS FOR DEVELOPMENT IN THE NEWBORN REQUIRING NEUROSURGICAL INTERVENTION

The long-term prognosis of the newborn infant destined for neurosurger y may depend in large part on preexisting neurologic disturbances. The ability to delineate preoperatively the likely long-term neurologic o utcome of such infants facilitates the formulation of optimal interven tions and the prediction of likely benefit of a specific intervention and addresses parental concerns for the likely outcome with and withou t neurosurgical intervention. This article describes two fundamental a pproaches, using clinical observations or laboratory investigations fo r delineating such a prognosis. Clinically important factors include t he underlying cause, the extent of associated parenchymal injury, and the nature of comorbid factors, particularly those of cerebrovascular and dysgenetic origin. Other important prognostic factors include the age at presentation, the rate of progression, and timing of interventi on. The use and limitations of current structural brain imaging, elect rophysiologic and perfusion studies, and newer neurodiagnostic techniq ues are discussed.