Hydrocephalus is one of the most commonly encountered clinical problems in neurosurgery and accompanies most cases of myelomeningocele. Spinal fluid shunting to the peritoneal cavity is the most common surgery performed for hydrocephalus, and there is a vast array of valve systems and hardware available. The authors present their techniques and refinements for placement of shunt systems and strategies to avoid complications. The medical management of hydrocephalus and shunt infections also is examined.