Aims: To provide long-term outcome data after treatment of hydrocephalus in children, and to identify risk factors for ventriculoperitoneal shunt (VPS) failure. Methods: Endoscopic third ventriculostomy (ETV) and VPS procedures in children between 2001 and 2005 were reviewed. Data collected prospectively included age at surgery, sex, aetiology of hydrocephalus, gestational age, emergency/planned surgery, duration of surgery, time of day, surgeon’s experience and other concomitant surgery. The mean follow-up was 4.7 years (min. 2 years). The endpoint was a new surgery due to failure of treatment, and the time to failure was noted. Risk factors for VPS failure were analysed by univariate Cox proportional hazards regression. Results: Ninety-eight patients were included, 76 with a VPS, 22 with an ETV. Fifty-five percent of ETV and 58% of VPS failed. Significant risk factors (p < 0.05) for VPS failure were prematurity (HR: 2.05; 95% CI: 1.12–3.76), concomitant procedure (HR: 2.07; 95% CI: 1.04–4.12) and long duration of surgery (HR: 1.23; 95% CI: 1.06–1.44), while sex, surgeon’s experience, shunt type, at what department the surgery was performed, whether the surgery was acute or elective, and time of day were not. Conclusion: Treatment failure occurred in >50% of patients after ETV and VPS. Prematurity and concomitant surgery were major risk factors for VPS failure.