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Endoscopic ventriculostomy is a specialized surgical procedure primarily used to treat conditions associated with obstructive hydrocephalus, a condition characterized by the accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain due to blockage in normal CSF flow pathways. The procedure involves the use of an endoscope, a thin, flexible tube equipped with a camera and surgical instruments, which allows neurosurgeons to access the brain's ventricular system through small incisions. This minimally invasive technique offers several advantages over traditional open surgery, such as reduced recovery time, less postoperative pain, and lower risk of complications. During the procedure, the surgeon navigates the endoscope through the brain's natural anatomical corridors, usually targeting the third ventricle or the foramen of Monro. Once access is gained, a small hole is created in the floor of the ventricle, allowing the excess CSF to drain into surrounding brain tissue, thereby bypassing the obstructed pathways. The creation of this opening is essential, as it alleviates the pressure caused by the buildup of fluid, restoring normal CSF circulation. The success of endoscopic ventriculostomy relies heavily on the precise identification of the anatomical landmarks within the ventricle and the skill of the surgeon. Patients typically experience significant symptom relief following the procedure, with many reporting improvements in headaches, balance, and cognitive function. The indication for endoscopic ventriculostomy may include congenital anomalies, tumors, or post-infectious causes of hydrocephalus. The procedure is particularly valuable in pediatric patients, where traditional shunting methods may be associated with higher rates of complications and failure. Postoperative assessments usually involve monitoring neurological status, conducting imaging studies, and evaluating CSF dynamics to ensure that the newly created pathway remains patent. Long-term outcomes for patients undergoing endoscopic ventriculostomy are generally favorable, with many achieving sustained resolution of hydrocephalus symptoms without the need for additional surgical interventions. It is essential for patients to be appropriately selected for this procedure, as anatomical variations in the ventricular system can influence the likelihood of success. In cases where endoscopic ventriculostomy is unsuccessful or not feasible, alternative treatments, such as ventriculoperitoneal shunting, may be considered. Overall, this innovative surgical approach represents a significant advancement in the management of hydrocephalus, offering hope and improved quality of life for many patients afflicted with this challenging condition. By harnessing the capabilities of modern endoscopic techniques, neurosurgeons can provide targeted interventions with minimal disruption to the surrounding brain tissue, highlighting the evolution of neurosurgical practices towards more refined and patient-centered solutions.