BACKGROUND It is the current status of fetal ventriculomegaly that although the technology for diagnosis is advanced, it does not have significant impact on the management outcome. Fetal ventriculomegaly is mainly treated after birth. METHODS We reviewed the literature and suggested policies of postnatal evaluation and surgical management of fetal hydrocephalus. Our experience of 44 cases of fetal ventriculomegaly diagnosed by fetal ultrasonography, in which major poor prognostic factors were absent and for which prenatal pediatric neurosurgical consultation was sought, was also presented. RESULTS Our experience showed etiologic heterogeneity of fetal ventriculomegaly although our cases seemed to be surgical candidates more likely than whole group of fetal ventriculomegaly. There were limitations in prenatal evaluation of fetal hydrocephalus. The first step for postnatal management is etiologic classification. It should be clarified after birth whether there is remarkable disturbance of cerebrospinal fluid dynamics or not. The rate of postnatal progression of ventricular dilatation is also important for the decision of treatment plan. For surgical treatment in very young children, special considerations should be paid on technical feasibility, rate of postoperative infection or malfunction, prevention of rapidly developing nervous system from the possible damage, and great plasticity of young brain. CONCLUSIONS Indication, methods, and timing of surgical treatment must be individually tailored according to the etiology, degree and rate of progression of ventriculomegaly, and patient's age when surgical treatment is considered.