In modern neurosurgery there has been a strong trend towards the use of minimally invasive techniques, one of which is intracranial endoscopy. Endoscopic third ventriculostomy (ETV) is the commonest procedure performed; it is used to treat hydrocephalus caused by an obstruction to the ventricular system anywhere distal to the mamillary bodies of the third ventricle. The obstruction is bypassed by a stoma created in the floor of the third ventricle, allowing cerebrospinal fluid (CSF) to flow freely into the subarachnoid space. Endoscopy can also be used for the fenestration of various intracranial cysts, intraventricular biopsy, the placement and retrieval of ventricular catheters, the removal of small intraventricular lesions, and improved visualisation in microsurgical operations. At Red Cross Children’s Hospital and Groote Schuur Hospital endoscopy has become an indispensable tool in the management of a wide range of neurosurgical conditions. As experience has accumulated worldwide, a better understanding of the benefits and limitations of endoscopy in diverse circumstances has emerged.