Background: A variety of medical specialists must provide hydrocephalus care for the rest of one's life. While acknowledged surgical alternatives for managing hydrocephalus, endoscopic third ventriculostomy (ETV) and ventriculo-peritoneal shunt (VPS) are controversial. In treating hydrocephalus, our goal was to evaluate the safety and effectiveness of ventriculoperitoneal (VP) shunt vs endoscopic third ventriculostomy (ETV). Subjects and methods: This Retrospective clinical study was conducted in the Neurosurgery Department at Helwan University Hospitals from January 2021 to January 2023. The participants were children (0–18 years) with obstructive/non-obstructive hydrocephalus caused by any etiology. This study included 56 cases that divided into two groups : group A was 28 and group B was 28.We found that the mean age of group A was 10.9 and 11 for group B. 60% of the group A were males and 65% of the group B. who underwent either ETV or VPS and the patients were followed up 3 months and 6 months. Results: The success rate between ETV 96.4% to VPS 70%. Length of stay for VP shunt was 4.1± 7 days and for ETV mean stay was 5 ± 3 days. there was less complication with the ETV in comparison to the VPS in many items. For example in infection its 7% in ETV vs 25%in VPS, and in obstruction its 3% for ETV vs 36% in VPS , but the rate of CFS leak in ETV is 21% vs 3%for VPS , and also the rate of Hemorrhage is 21% for ETV vs 7% for the VPS , and 46% of the ETV had no complication vs 29% of VPS