Objective: To compare the effects of laparoscopic-assisted ventriculoperitoneal (V-P) shunt surgery versus conventional V-P shunt surgery on postoperative neurological function and complications in patients with hydrocephalus. Methods: A retrospective study was conducted on 160 patients with hydrocephalus treated at our hospital from August 2022 to December 2024. Patients undergoing laparoscopic-assisted V-P shunting were assigned to the observation group (n=93), while those undergoing conventional V-P shunting were assigned to the control group (n=67). Comparisons were made between the two groups for surgical-related indicators (surgery, intracranial pressure relief, hospitalization duration), intracranial hemodynamic parameters [anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), basilar artery (BA), bilateral vertebral arteries (VA) mean blood flow velocity), neurological function [National Institutes of Health Stroke Scale (NIHSS)], motor function [Fugl-Meyer motor score], activities of daily living [Barthel Index (BI) score], and complication incidence. Results: The observation group demonstrated significantly shorter operative and hospitalization durations compared to the control group [53.87 ± 6.80 min vs 103.21 ± 12.35 min, 7.15 ± 1.00 days vs 9.53 ± 1.23 days; P < 0.05]. The time to resolution of intracranial hypertension showed no statistically significant difference between groups [(25.11 ± 3.18) vs (26.07 ± 4.03) min] (P > 0.05). At 1 month postoperatively, blood flow velocities in the ACA, MCA, PCA, BA, and VA showed no statistically significant differences between groups (P < 0.05). At 1 and 6 months postoperatively, NIHSS scores gradually decreased in both groups, with the observation group consistently lower than the control group. At 6 months postoperatively, the observation group exhibited higher Fugl-Meyer and BI scores than the control group: (77.42 ± 14.38) vs. (63.88 ± 10.27) points, (84.25 ± 12.37) vs (63.92 ± 11.00) points], with statistically significant differences (P < 0.05). The overall incidence of complications showed no statistically significant difference between the two groups (P > 0.05). Conclusion: Laparoscopic-assisted ventriculoperitoneal shunt surgery demonstrates significant advantages in treating hydrocephalus, effectively improving patients" neurological function, motor function, and activities of daily living. It warrants clinical promotion and application.