HCRN Chairman John Kestle and HCRN investigator Jay Riva-Cambrin were published in AANS Neurosurgeon this month in counterbalancing articles about changes in treatment of hydrocephalus and the impact of new procedures going forward. Dr. Riva-Cambrin discusses his observations in nuances of the treatment of hydrocephalus since he was trained as a neurosurgeon in the late 1990s. He highlights the re-emergence of the endoscopic third ventriculostomy with the addition of choroid plexus coagulation and the potential for changing the default treatment of hydrocephalus with a shunt. Dr. Kestle’s article provides the counterpoint that despite these innovations, shunts are the “workhorse” of hydrocephalus treatment and we must continue to improve the outcomes for patients treated with a shunt. Both of these articles make for interesting reading about the evolution of hydrocephalus treatment.