Objective This paper discusses indications for and the technique of endoscopic aqueductoplasty with stenting. Methods We review and summarize the clinical experience with endoscopic aqueductoplasty gained over the last 15 years on pediatric and adult patients. Results Endoscopic aqueductoplasty with stenting presents a safe procedure. In well selected patients, it provides a long-term, stable clinical course. Aqueductoplasty alone has a high reclosure rate and should be avoided. Conclusions Aqueductoplasty with stenting is the procedure of choice for the treatment of isolated fourth ventricle. Membranous and tumor-related aqueductal stenosis should be treated by endoscopic third ventriculostomy.