A consecutive series of 120 patients with infantile hydrocephalus who were subjected to ventriculoatrial shunting was studied. The average length of follow-up was 11 years. Operative mortality was zero. Seven patients died during the follow-up period; in all cases but one of these the cause of death was not a consequence of a shunt-related procedure. The incidences of infection and slit ventricle syndrome were 4.2% and 1.8% respectively. Two hundred and fifty-three shunt revisions were performed, yielding a revision rate of 2.2 per patient. Of these 253 revisions 167 (66%) were elective lengthening of the atrial catheter. The number of reoperations for adjusting the length of the atrial catheter of for revision of the distal end of the shunting system is a major disadvantage of ventriculoatrial shunting which actually speaks in favor of ventriculoperitoneal shunting as the primary procedure for the treatment of pediatric hydrocephalus.