Background <p>Hydrocephalus is one of the most common brain disorders in pediatric patients. It is a highly complex condition and a leading cause of neurological sequelae, primally resulting from prematurity, intraventricular hemorrhage, or infections.</p> Case presentation <p>We present the case of a 5-month-old male with a medical history of emergency cesarean delivery at 31.5 weeks due to preeclampsia, who developed grade IV intraventricular hemorrhage with secondary obstructive hydrocephalus and multicystic encephalomalacia. Initial management with a ventriculoperitoneal shunt was complicated by malposition of the proximal ventricular catheter. The patient subsequently underwent a neuroendoscopic procedure, which included third ventriculostomy, septal fenestration. We also performed an endoscopic repositioning of the proximal catheter.</p> Conclusions <p>This endoscopic maneuver successfully avoided a more invasive procedure for removal and complete replacement of a new shunt system.</p>