The formation of hydrocephalus is like a blockage in a sewer, caused by an obstruction in the cerebrospinal fluid circulation pathway. Similarly, the treatment of hydrocephalus is like unblocking a blocked sewer pipe, which requires a special tool for unblocking the pipes. Soft endoscopy is a new type of tool for unblocking the cerebrospinal fluid circulation pathway, with a diameter of only 3.8 mm, equivalent to the thickness of chopsticks. Because of its soft, slender and flexible nature, it can unblock a wider range of cerebrospinal fluid circulation pathways through a small incision of about 3 cm in the head, which has its unique advantages in the diagnosis and treatment of hydrocephalus, with less trauma, faster recovery, better results, and low cost, and avoiding various complications after shunt surgery. In terms of diagnosis, flexible endoscopy allows comprehensive exploration of the entire ventricular system, including the fourth ventricle, and more accurate determination of the etiology of hydrocephalus. In terms of treatment, firstly, according to the results of ventricular exploration, endoscopic brain washing surgery can be performed to completely remove the “dirt” in the ventricles with hemorrhage or infection; secondly, for hydrocephalus with clear obstruction, individualized evacuation can be performed, including catheterization and evacuation of the outflow tract of the fourth ventricle, so that the cerebrospinal fluid can be restored to normal Physiological circulation. In cases where evacuation is difficult, intracerebroventricular bypass can be performed through a third ventriculostomy. In addition to the most common third ventricular floor, the soft endoscopic third ventriculostomy can be performed with a forward endplate fistula or a backward third ventricle-superior cerebellar pool fistula. In addition, flexible endoscopy can be used to reduce cerebrospinal fluid secretion to treat refractory hydrocephalus through adjunctive choroid plexus cautery, which can be performed through a single incision to cauterize the choroid plexus in the lateral ventricles and the fourth ventricle bilaterally with more definitive results. Therefore, soft endoscopic personalized surgery for hydrocephalus will definitely become a trend in hydrocephalus treatment. It is important to note that although flexible endoscopy can be used to unblock a wider range of cerebrospinal fluid circulation, there are areas where it cannot reach, in which case the only option is cerebrospinal fluid shunt surgery to treat hydrocephalus.