Background: The position of the ventricular catheter (VC) is essential for a proper function of cerebrospinal fluid diversion system. A shuntoscope-guided (SG) method might be helpful in reducing complications. Objective: The purpose of this study is to compare the accuracy of catheter placement and the complication and revision rates between SG and free hand (FH) techniques. Methods: A prospective study of patients who underwent VC placement between September 2018 and March 2021. Accuracy of catheter placement was graded on postoperative imaging using three-point Hayhurst grading system. Complication and revision rates were documented and compared between both groups with an average follow up period of 19.56 months. Results: Fifty-five patients were included. SG technique was used in 29 patients (mean age was 6.3 years, 1.4 –27.7 years, 48.1% females), and FH technique was used in 26 patients (mean age was 28.6 years, 1.0 – 79.5 years, 73.1% female). The success rate for the optimal placement of the VC with a grade I on the Hayhurst scale was significantly higher in the SG group (93.1%) than in the FH group (67%), P = 0.031. The revision rate was higher in the FH group with 31.8% vs. 20.7% of in the SG group, P = 0.396. Conclusion: VC placement using the SG technique is a safe and effective procedure, which enabled a significantly higher success rate and lower revision and complication rate. Accordingly, we recommend using the SG technique specially in patients with morbid anatomy.