Abstract
Introduction: The use of neuroendoscopic for the management of myelomeningocele-associated hydrocephalus is still controversial. Anatomic variations and abnormalities of the ventricular system and the confusing topography of the floor of the third ventricle are of utmost importance in this approach. 
 Case presentation: The present case video displayed a case of a 4-year-old girl with myelomeningocele related hydrocephalus presented with a closure of third ventriculostomy after tethered cord release. Several neuroendoscopic options were depicted such as third ventriculostomy using bipolar diathermia, ventriculocystostomy of a quadrigeminal arachnoid cyst and a choroid plexus cauterization as a strategy to improve the success rate of this procedure and handle the difficulties presented in this form of hydrocephalus.
 Discussion: This video warned the young neurosurgeons regarding ventricular anatomic challenges presented in this case as well as the need of customization of neuroendoscopic approach.
 Conclusion: Neuroendoscopic approach is an effective strategy to manage myelomeningocele-associated-hydrocephalus.
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