Ventriculostomy for hydrocephalus can either obviate completely or reduce considerably the complications of cerebrospinal fluid (CSF) shunts. Renewed interest in this procedure has followed the development of flexible and steerable neuroendoscopes, high-quality video cameras, endoscopic surgical instruments, including lasers, and methods of providing computer-guided stereotactic assistance. Ventriculostomy is the preferred treatment for patients with congenital aqueduct stenosis that requires CSF diversion. It is less successful in patients with acquired aqueduct stenosis but is still a treatment option. Interventriculostomy for treatment of intracranial cysts or loculated regions of the ventricles also can obviate or reduce the need for CSF shunts.