OBJECTIVE: With neurosurgeons\' mastery, endoscopic third ventriculostomy (ETV) and extracranial shunting, two surgical options for patients with noncommunicating hydrocephalus, have substantially enhanced. However, which method of these 2 surgical methods could be more beneficial and safe for obstructive hydrocephalus is controversy. Herein, in patients with noncommunicating hydrocephalus, we did a meta-analysis to investigate the safety and efficacy of the two surgical therapies. METHODS: Randomized controlled trials (RCTs) of ETV and VPS for obstructive hydrocephalus were searched systematically by using MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. Reference lists of retrieving studies were also perused. Infection following surgery, postoperative CSF leakage, mortality and success following surgery were the main outcomes. RESULTS: Six RCTs evaluating ETV and VPS were observed from among 841 studies evaluated. Especially in comparison to VPS, ETV was accompanied with decreased incidences of infection following surgery (risk ratio [RR] 0.19, 95% confidence interval [CI]: 0.08-0.43, P = 0.0001); postoperative cerebrospinal fluid leakage (RR 5.10, 95% CI: 1.19-21.89, P = 0.03) compared with ventriculoperitoneal shunt; VPS had no incidence on mortality rates as compared to ETV (RR 0.64, 95% CI: 0.26-1.56, P = 0.32). CONCLUSIONS: In comparison to ETV, VPS had no significant effect on the incidence rate of mortality, but ETV has more benefits in terms of major complications, such as infection following surgery, and postoperative CSF leakage, than VPS for patients with noncommunicating hydrocephalus, according to the above meta-analysis.