Purpose Ventriculoperitoneal (V-P) shunt is one of the most common neurosurgical procedures in pediatrics for the treatment of hydrocephalus. Shunt failure is one of the common mechanical complications which lead to major morbidities. This study aims to compare between cranial part insertions of the V-P shunts guided by trans-anterior fontanel ultrasound versus conventional insertion. Methods A prospective comparative randomized study was conducted on 60 pediatric patients aged≤2 years who suffered hydrocephalus and allocated into 2 groups. In the first group (n=30), the cranial parts of the ventriculoperitoneal shunts were inserted guided by trans-anterior fontanel ultrasound, and in the second group (n=30), the insertions were by the conventional method. The follow-up duration of the patients was 3 months. Results Proximal part obstruction of the V-P shunt was found in 3 cases of the conventional group during follow-up with statistical insignificance (p=0.237) while adequate proximal part location recorded statistical significance (p=0.0005) in favor of ultrasound-guided group. Conclusion The use of the anterior fontanel ultrasound guide during ventriculoperitoneal shunt insertion is a feasible, safe, and effective technique for the placement of ventricular catheters in pediatric patients with a patent anterior fontanel.