Giving opportunity to avoid placement of shunt systems, endoscopic third ventriculostomy (ETV) has revolutionized the management of hydrocephalus. With increasing experience, indications for ETV are being continuously reviewed and expanded. We report a retrospective analysis of our experience with 40 consecutive patients who have undergone ETV procedure in the past 5 years. The patient population was heterogeneous, ranging in age from 4 weeks to 67 years, with a variety of diagnoses. We reviewed controversial issues regarding this procedure, including age and indications.