Review of a series of 440 children treated for hydrocephalus shows that the commonest cause of this condition in Cape Town is meningitis, both bacterial and tuberculous, followed by congenital anomalies and brain tumours. Ventriculoperitoneal shunts were used to treat the majority of cases while lumboperitoneal shunts were reserved for patients with communicating hydrocephalus. Ventriculo-atrial shunts were only used twice. Blockages affected 20% of cases but usually occurred within 3 months of surgery.