Introduction: Hydrocephalus, it is an excessive accumulation of cerebrospinal   ?uid within the head. It can be due to congenital or acquired. It leads to increase in    intracranial pressure, seizures, permanent disability and sudden death, for which patients has to undergo external ventricular drain, lumbar shunts or ventricular
shunts. Patients with intracranial pathology have high risk of perioperative  complications, which needs specifc anaesthetic management.  Case Report: A 32 year old male a case of status post right temporo-parietal
craniectomy with obstructive hydrocephalus posted for ventriculo-peritoneal  shunting. He sustained head injury 2 months back for which he had undergone  craniectomy and also tracheostomised. Then he was newly diagnosed as diabetic and hypertensive for which he was on medication. And his blood investigations
showed hyponatremia for which he was started on sodium correction. In between,  he had developed left cephalic vein thrombosis for which he was started on  injection Heparin. After 2 months of craniectomy he developed cerebral edema following which his GCS was also worsened. So ventriculoperitoneal shunting
was done under general anaesthesia and it was uneventful. Conclusion: As the patient was posted for ventriculoperitoneal shunting with  known history of status post craniectomy, hyponatremia and high blood sugars;  early hemodynamic management and intensive care was extremely useful to these  patient in view of anticipation of seizures, bleeding. In this case, the anaesthetic management was handled successfully without any consequences.  Key Messages: In patients with increased intracranial pressures due to various  reasons, shunting is advised to reduce the pressures by draining the excess cerebrospinal ?uid into the peritoneum. This gives temporary relief to the brain, reducing  the edema and reversing the effects of increased pressures in the central nervous  system. Our patient was a post traumatic case presented with hyponatremia
requiring ventriculo-peritoneal shunt. We had to correct the hyponatremia  anticipating convulsions, utmost care was taken perioperatively with a successful  outcome.