The growing awareness of mechanical and infectious complications related to the implantation of extracranial CSF shunts and the rapid developments in neuroendoscopic surgery have given pediatric neurosurgeons the possibility of choosing between the two types of treatment. The decision will depend on a number of factors, such as whether it is possible to identify the etiology of the hydrocephalus on the preoperative examinations, the surgeon's familiarity with the endoscopic technique, and his or her personal opinions about the efficacy of the alternative techniques to shunt implantation. The history and the state of the art of the alternatives to shunting are briefly reviewed for each of the main pathophysiological groups of pediatric hydrocephalus: aqueductal stenosis, posterior fossa tumors, meningomyelocele, Dandy-Walker malformation, posthemorrhagic hydrocephalus and others.