Background: Since hydrocephalus (HC) frequently co-occurs with other children and adult intracranial illnesses, the prevalence of the condition in the general population is unknown. The most frequent procedure used to treat hydrocephalus is the placement of a ventriculoperitoneal (VP) shunt. Objective: The aim of the present study was to focus on the use of the anterior fontanelle ultrasound guide in ventriculoperitoneal shunt to get the best results of the surgical operation with low complication and consequently improve the clinical outcome of the patient and save the money and time. Patients and methods: A prospective study included 50 cases ≤ 2 years suffering from hydrocephalus and were conducted to Neurosurgery Department, Faculty of Medicine, Zagazig University. Patients were divided equally into 2 groups; the first group of patients had ventriculoperitoneal shunt with anterior fontanelle ultrasound guided technique. The second group of patients had a conventional ventriculoperitoneal shunt technique. All patients were followed up for 3 months postoperatively. Results: There was no significant difference found between ultrasound guided and conventional groups as regard clinical examination. There was no significant difference found between groups as regard preoperative imaging. There was no significant difference found between groups as regard postoperative imaging data. There was no significant difference between groups as regard complications except 20% had a proximal obstruction in conventional group. Conclusion: Using anterior fontanelle ultrasound guided technique during cranial end insertion of the ventriculoperitoneal shunt is safe and achieves outcomes better than conventional techniques. Additional effort to improve the rate of accurate location should focus on making the ultrasound as a standard in cranial end shunt insertion.