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Endoscopic third ventriculostomy (ETV) is a minimally invasive procedure commonly used to treat obstructive hydrocephalus. The objectives of the procedure are to fenestrate the floor of the third ventricle using a neuroendoscopic approach and to provide a cerebrospinal fluid (CSF) diversion. With high success rates published over the years, ETV became a routine modality for the obstructive hydrocephalus treatment. Furthermore, indications for ETV are expanding day by day and are no longer limited to obstructive hydrocephalus. Endoscopic third ventriculostomy has lower complication rate and has significant advantages compared to other CSF diversion techniques. Efficiency and safety of ETV are increasing with the advancements in technology.