The use of shunting for hydrocephalus has a long history of improvements made through basic science, clinical innovations, and biomedical products. Shunting has dramatically changed the outlook of children with hydrocephalus, with many of them having normal life expectancies and attaining normal intelligence. The use of shunts, however, has created many unique problems of shunt dependence with frequent shunt revisions being the rule for most hydrocephalic children. Shunt problems assume a major amount of all neurosurgeons' efforts. In addition, the slit-ventricle syndrome has posed many new questions regarding what the post-shunting ventricular size should be and what problems are created by having a slit-like ventricular system. This article reviews current concepts of childhood hydrocephalus with respect to the various hydrocephalic syndromes and provides detailed descriptions of problems unique to various shunting systems. In addition, the slit-ventricle syndrome is distinguished from asymptomatic slit-ventricles after shunting. The various forms of the slit-ventricle syndrome are described, and proposed guidelines for classifying, working up, and treating the slit-ventricle syndromes are provided.