Cerebrospinal fluid diversion is the only established treatment for hydrocephalus. Despite significant advances in the shunt technology and development of diverse type of proximal catheters and valves, there has been only a marginal impact on the rate of malfunction and shunt-related complications. Although individual cases may benefit from use of devices used to decrease overdrainage from the shunt, studies conducted to evaluate these devices have not shown significant long-term or short-term benefit from their use. Endoscopic surgery has provided alternative strategies in patients with isolated ventricles or obstructive hydrocephalus. However, there is limited data in literature to suggest that long-term survival of third ventriculostomy is superior to that of a shunt. This article reviews the available literature and controversies in management of hydrocephalus using the above strategies.