I have met many families who, when it comes to hydrocephalus and the need for shunts, first consider the need for lifelong tubes, possible blockage of the shunts, infection, etc. The key is the comparison of risk and benefit. Endoscopic fistulas have only been available for the last decade or two, while shunts have been available for over a century. Is it better to have an endoscopic fistula or a shunt for hydrocephalus? First of all, it depends on what type of hydrocephalus your child has. Endoscopic fistula is only suitable for obstructive hydrocephalus, while traffic hydrocephalus is not an indication. The ideal treatment for hydrocephalus is to reduce the size of the ventricles to the level of a normal child, restore the brain volume to the level of a normal child, and gradually restore the child’s intellectual motor development to the level of a normal child. Finally, in terms of surgical damage, the complications of shunt surgery in the acute phase are mainly bleeding and infection, and in the distant phase, blockage of the tube. In contrast, in addition to bleeding and infection, the acute phase of endoscopic fistulotomy includes hypothalamic injury, postoperative hyperthermia, electrolyte disturbance, endocrine changes, neurological injury, epilepsy, subdural effusion, etc. The chance of blockage of the fistula in the distal phase is also high, and many of them grow back after 3-6 months postoperatively, leading to recurrence of hydrocephalus. If the ventricles do not shrink and the brain volume does not increase after surgery, even if the symptoms improve, it does not mean that the treatment is necessarily effective, because some patients already had static hydrocephalus before surgery. Recently, there was a case of severe hydrocephalus patient outside the hospital after endoscopic fistula, the ventricle from severe enlargement to moderate enlargement, the effect is obvious, the family is full of joy, but 3 months after surgery, the child appeared recurrent headache and vomiting, do lumbar puncture cranial pressure of 250mmH2o or more, why? The fistula is growing! The doctor should choose the treatment objectively according to the type of hydrocephalus and tell the patient the advantages and disadvantages of the treatment to avoid misleading the family members who are concerned about putting the shunt and avoiding fistula first and then shunt. Families should also choose their treatment calmly and objectively, refusing to be fooled, ultimately it is to see the results of treatment. Science is constantly evolving, and who knows what will happen in ten or twenty years? Shunts have evolved from the use of sheep intestines, plastic tubes, and metal tubes a century ago to the sophisticated high-tech devices that can regulate pressure, resist infection, and resist siphoning today, and will continue to evolve in the future. So choose your treatment wisely and don’t be afraid to place a tube, it’s more important than anything else to get your child’s brain developing now.