Background: The position of the ventricular catheter (VC) is essential for a proper function of cerebrospinal fluid diversion system. A ShuntScope®-guided (SG) method might be helpful in reducing complications. The purpose of this study is to compare the accuracy of catheter placement and the complication and revision rates between SG and free hand (FH) techniques. Methods: A retrospective study based on a prospectively acquired database of patients who underwent VC placement between September 2018 and July 2021. Accuracy of catheter placement was graded on postoperative imaging using three-point Hayhurst grading system. Complication and revision rates were documented and compared between both groups with an average follow up period of 20.84 months. Results: Fifty-seven patients were included. SG technique was used in 29 patients (mean age was 6.3 years, 1.4 –27.7 years, 48.1% females), and FH technique was used in 28 patients (mean age was 26.7 years, 0.83 – 79.5 years, 67.9% female). The success rate for the optimal placement of the VC with a grade I on the Hayhurst scale was significantly higher in the SG group (93.1%) than in the FH group (60.7%), P = 0.012. The revision rate was higher in the FH group with 35.7% vs. 20.7% of in the SG group, P = 0.211. Conclusion: VC placement using the SG technique is a safe and effective procedure, which enabled a significantly higher success rate and lower revision and complication rate. Accordingly, we recommend using the SG technique especially in patients with difficult anatomy.