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Objective: To know the surgical outcome of endoscopic third ventriculostomy (ETV) in non communicating hydrocephalous. Materials and methods: This study was conducted in Abaseen Hospital, Peshawar, from 13th December 2010 to 12th October 2011. Patients with non-communicating hydrocephalous, irrespective of gender discrimination were included in this study. Patients with communicated hydrocephalous, patients below two years of age and hydrocephalus with infected CSF or hemorrhage were excluded. Hydrocephalous was diagnosed on CT scan brain. The procedure was done under general anesthesia. Clinical Outcome of ETV was evaluated by the time of discharge and on subsequent follow up visits i.e. monthly for the first three months and then at six months. Any patient who subsequently needed VP shunting after the ETV procedure was described as having treatment failure. Results: We operated 27 patients during our study period. Age ranged from 2 years to 57 years with mean age 20.8 years. There were 16(59.26%) males and 11(40.74 %) females. Etiologically,4th ventricular tumors was present in 9 patients(33.33%), tuberculous meningitis in 8(29.62%), aquiductal stenosis in 7(25.92%), brain stem glioma in 1(3.70%). cerebellar haemengioblastoma in 1(3.70%) and pineal tumor (3.70%) with infra tentorial extension in 1 (3.70%) patient. The procedure was successful in 24(88.89%) patients and converted to ventriculoperitoneal shunts in 3(11.11%) cases. Post operatively CSF leakage was present in 2 (7.40%) patients, transient memory loss in 1(3.70%), pneumocephalus in 1(3.70%) and pseudomeningocele in 1(3.70%) patients. Conclusions: Endoscopic third ventriculostomy is a good alternative to the VP shunt in cases of non-communicating hydrocephalous. Although ETV does have some complications but these are transient and can be minimized with proper patient selection and meticulous surgical technique. [ABSTRACT FROM AUTHOR]