Objective: To compare the outcomes of children aged 2 years and below with hydrocephalus treated with ventriculoperitoneal shunt placement and endoscopic third ventriculostomy with choroid plexus cauterization as well as identify risk factors for their failure at the Neurosurgery unit of the Lagos University Teaching Hospital. Materials and methods: This was a prospective hospital based study involving 56 patients carried out over a 16 month period . Patients who met the inclusion criteria for the study were randomized into 2 groups (ventriculoperitoneal shunt placement and Endoscopic third ventriculostomy with choroid plexus cauterization) to meet the sample size. The biodata with clinical and radiological features of hydrocephalus were documented. Informed consent for research and surgery was obtained. ETV/CPC or VPS was done under general anaesthesia and patients were followed up at 1 month, 3 months and 6 months or until there is failure if this predates the 6th month. Outcome measure of success is recorded if there is an improvement in the preoperative clinical features. Failure is recorded if the converse occurs. Result: A total of 56 patients (28 for each group) were recruited and completed the study. No patient was lost to follow up. The mean age at surgery for the VPS group was 4.54months while it was 4.86 months for the ETV/CPC group. The overall morbidity was higher in the VPS group with 2 cases of wound infection and 3 cases of CSF leak, a single case of wound dehiscence was recorded in the ETV/CPC group. At the end of 6 months of follow up, the success rate for VPS and ETV/CPC was 82.1% and 75.0% respectively, though the difference was not found to be significant. Conclusion: ETV/CPC is a viable alternative to VPS in the treatment of hydrocephalus in children. VPS seems to have a higher morbidity than ETV/CPC.