Progressive hydrocephalus is a serious complication in patients with aneurysmal subarachnoid hemorrhage. The choice between adjustable or nonadjustable pressure shunts for the treatment of this type of hydrocephalus remains difficult to define. The variability of intracranial pressure adds to the difficulty in choosing the best treatment. Numerous clinical studies have shown that adjustable pressure shunts have shown advantages in reducing problems with the shunt system, but they are three times more expensive than non-adjustable shunts. Scholars in neurosurgery at the National Institute of Neuroscience in Singapore conducted a study suggesting that adjustable-pressure shunts are less likely to require revision surgery and have a higher overall cost-effectiveness, published online in the April 18, 2014, issue of Journalof Neurosurgery. The study included all patients with hydrocephalus secondary to aneurysmal subarachnoid hemorrhage who underwent ventriculoperitoneal shunts between 2006 and 2012. Patients were divided into a pressure-adjustable shunt group and a non-pressure-adjustable shunt group. The rate of shunt revision, the reasons for adjustment of the shunt device in patients with adjustable pressure shunts, and the effectiveness of adjustment were analyzed separately. In addition, a cost-benefit analysis was performed to determine whether the overall cost of the adjustable shunts exceeded that of the non-adjustable shunts. Adjustable shunts allow for non-invasive adjustment of pressure settings after problems with the shunt system, thereby avoiding the need for shunt revision. The results of the study also showed that patients with adjustable pressure shunts were less likely to undergo shunt revision and therefore more cost effective. In addition, the shunt adjustments made in patients with adjustable shunts also resulted in better neurological outcomes. This study is of great clinical relevance for our developing countries, where patient affordability is low. It is worth promoting its use in patients with hydrocephalus secondary to aneurysmal subarachnoid hemorrhage. Further expansion of the study is also worthwhile in the treatment of other hydrocephalus.