Objective: The aim of the study was to establish optimal diagnostic and therapeutic scheme and to assess the efficacy of intrauterine therapy of hydrocephalus. Material and methods: The study was carried out between 1992-2012 on the total of 222 fetuses with hydrocephalus, using Orbis-Sigma and ACCU-Flow valves (168 cases) and Cook’s shunts, according to a strictly defined diagnostic and therapeutic scheme. Results: In the first stage of the study (between 1992-2001), a total of 168 fetuses with prenatally diagnosed hydrocephalus received intrauterine therapy. In 91.6% of the cases the therapy resulted in a decreased size of cerebral ventricles. The valve dislocated in 23 cases (13.6%). Preterm delivery occurred in 44% of the affected neonates. Severe mental impairment occurred in 17.76%, average in 36.8%, and slight in 32.9% of the infants. Normal mental development at the age of 3 was observed in 12.5% of the children. A total of 11.2% of children did not require further neurosurgical reatment. In the second stage of the study (between 2006-2012) after therapy, the size of the right lateral cerebral ventricle decreased by 54.76% (average of 27.54 mm to 12.46 mm) and the left lateral cerebral ventricle decreased by 53.12% (average of 26.41 mm to 12.38 mm ) (p=0.0018). The maximum and minimum width of the cerebral cortex increased by 23.06% and 27% (average of 9.04 mm to 11.75 mm vs. 3.65 mm to 5mm), respectively. Early complications were observed in 22% of the cases: PROM (6), intrauterine fetal death (4), intrauterine infection (1), and premature detachment of the placenta (1). Average gestational age at delivery was 34 weeks, and 24% of the patients delivered at term. Conclusions: • Implantation of ventriculo- amniotic shunts proved to be an effective form of therapy, resulting in normalization of intracranial pressure. • In both stages of therapy, reduction of ventricular size in patients with hydrocephalus and good neurological outcome (45.4% in I stage, 60% in II stage) were observed • In the second stage of therapy, the size of lateral brain ventricles after fetal therapy was significantly lower (54%). A total of 18% of the neonates did not require neurosurgical treatment.