Introduction 29 5 6 7 24 26 27 17 20 4 13 19 10 12 21 15 22 TVS by lamina terminalis fenestration is still a routine procedure in aneurysm surgery for subarachnoid hemorrhage, especially in case of anterior communicating artery aneurysms. However, the possibility of a microsurgical TVS (MTV) for obstructive hydrocephalus seems to be lost to oblivion by the widespread use of ETV. In this report, we describe two patients in whom an ETV could not be performed because of slit ventricles and who became shunt independent after MTV by a minimally invasive supraorbital approach. Case reports Case 1 2 1 2 1 Fig. 1 a b c d e f  Fig. 2 Postoperative photograph of case 1 showing the hardly visible scar of the eyebrow incision  Case 2 2 3 Fig. 3 a b c d  Discussion 9 14 18 8 9 18 10 16 30 10 1 23 25 2 3 2 7 5 24 21 17 Operative technique Many neurosurgeons consider craniotomy and MTV too large and risky a procedure. However, the procedure described in this report is a truly minimally invasive procedure. The operation time is about 1 h, the wound and scar are minimal, recuperation is very fast, and the potential risks are very low. One might even suggest that this procedure is safer than an ETV because it has an extracerebral approach, in contrast to ETV, and that surgery is better controlled with more opportunities for hemostasis. 28 Recovery of this operative procedure is fast and without major side-effects. Usually, hospitalization time is 2 to 3 days. Conclusion In conclusion, open microsurgical third ventriculocisternostomy by opening the lamina terminalis should be kept in mind as an alternative technique for treating patients with multiple shunt failures and small ventricles not accessible for an endoscopic approach in an effort to make these patients shunt independent.