Abstract: Objective To study the application of one-stage operation of ventriculo-peritoneal shunt and cranioplasty for hydrocephalus complicated by skull defect.Method The clinical records of 54 patients with hydrocephalus complicated by skull defect treated with one-stage operation of ventriculo-peritoneal shunt and cranioplasty were reviewed in comparison with those of 30 patients receiving two-stage operations.Result The clinical outcome of the patients receiving the two surgical procedures did not differ significantly, but two patients undergoing one-stage operation required replacement of the shunt pump due to elevation of intracranial pressure. Implementation of one-stage operations shortened the length of hospital stay and reduced the expense of patients.Conclusion Hydrocephalus in combination with skull defect can be treated generally with one-stage operations and care must be taken in choosing adequate shunt tube according to the intracranial pressure measured preoperatively.