Objective To compare the value of ventricular irrigation and conventional cerebrospinal fluid (CSF) exchange in hydrocephalus with an elevated CSF protein level.Methods We selected 90 patients diagnosed with hydrocephalus and an elevated CSF protein level in our hospital from January 2015 to August 2018. They were randomly divided into three groups:ventricular irrigation group, external ventricular drainage group, and external lumbar drainage group, with 30 cases in each group. When the CSF protein concentration was <500 mg/L, ventriculoperitoneal shunt surgery would be performed. We recorded CSF protein concentrations at 7 d and 14 d after surgery, time to shunting, and the incidence of intracranial infection and drain blockage.Results Time to shunt operation was 1.87 d in the ventricular irrigation group, significantly shorter than that in both conventional groups (P<0.01). The CSF protein level averaged 523.45 mg/L in the ventricular irrigation group at 7 d after operation, significantly higher than those in the two control groups (P<0.05), but showed no significant differences between the three groups at 14 d post operation. In the external ventricular drainage group, 30% developed intracranial infection, which was significantly higher than that in the ventricular irrigation group (P<0.05). There was no significant difference in the incidence of drain blockage between the three groups.Conclusions Ventricular irrigation can significantly bring forward shunt operation for patients with hydrocephalus and an elevated CSF protein level, showing promise for clinical application.