Abstract: Objective To review our experience in the treatment of hydrocephalus caused by aqueduct obstruction with neu-roendoscopic third ventriculostomy. Method Of the 12 patients with hydrocephalus, 10 had primary aqueduct obstruction with the other 2 suffering the obstruction secondary to tectal tumors. In all the cases the neuroendoscope was advanced into the third ventricle via the frontal horn and foramen of Monro, followed by third ventriculostomy to achieve free communica-tion between the third ventricle and interpeduncular cistern. Results All the procedures were successful and smooth, with on-ly occasional mild intra- and post-operative complications. Nine of the 12 patients were followed up 3 months after the opera-tion, and 7 were found with good therapeutic effect while 2 failed to respond favorably. Conclusions Neuroendoscopic third ventriculostomy is effective for hydrocephalus due to aqueduct obstruction, and may yield satisfactory short-term results. Dif-ferent techniques of fenestration should be used to suit the individual-specific conditions of the third ventricle floor. In the fol-low-up of the patients, evaluation of the intracranial pressure and the patients’ symptoms constitutes the main basis for assess-ment of the clinical results.