Intraventricular neuroendoscopy has become an important tool in the armamentarium of the neurosurgeon dealing with complex lesions within the ventricular system. Endoscopic approaches are useful for obtaining tissue samples for histopathological analysis, diverting CSF in complex hydrocephalus, and for the complete excision of ventricular tumors. Knowledge of intraventricular anatomy is crucial to minimize complications and plan surgical approaches effectively. The use of ancillary technology like stereotactic frameless neuronavigation can increase accuracy and minimize complications. Although larger ventricles are easier to navigate, normal or small ventricles are not a contraindication for an endoscopic approach.