BACKGROUND In accordance with the literature on ventriculoatrial (VA) shunts, a percutaneous approach to the internal jugular vein is preferable to surgical preparation of the vein before catheter placement. Inspired by the above and the problems still remaining in the percutaneous method and successful results from anaesthesiology with the use of ultrasound-guided placement of central venous catheters, we have implemented an ultrasound-guided percutaneous technique for placement of VA shunts including pre- and intraoperative ultrasound guidance. METHODS Data on 26 VA shunt operations were collected and analysed with special reference to the applicability of the method to pediatric patients, surgical complications and differences between revisions and first-time VA shunts. CONCLUSIONS All patients with VA shunt indications were operated successfully with this technique including children down to the age of 5 years. The ultrasound-guided percutaneous technique results in a safe, quick and easy procedure with preoperative knowledge of the diameter of the vein, no accidental carotid artery puncture or pneumothorax, a minimal blood loss, a short operative time, few infectious complications and a good cosmetic result. Results for all parameters were identical in first-time VA shunt operations and revisions.