Purpose <p>Hydrocephalus is a common complication of high-grade glioma (HGG). However, the indications for and prognostic impact of shunt placement remain unclear. We aimed to assess the shunt placement effectiveness and safety for hydrocephalus in patients with HGG and identify clinical factors associated with neurological and survival outcomes.</p> Methods <p>We retrospectively identified HGG patients with communicating hydrocephalus (CH) treated at our hospital between October 2010 and December 2024. Patient characteristics, changes in Karnofsky Performance Status (KPS) before and after shunt placement, and survival were analyzed in these patients.</p> Results <p>During the study period, 31 HGG patients underwent shunt placement for CH. For the patients, positive lumbar tap test results and a shorter duration from KPS decline to shunt placement were significantly associated with greater KPS improvement in analyses (<i>p</i> = 0.034 and 0.043). No patients showed KPS improvement when shunt placement was performed more than three months after KPS decline. For the patients who experienced an improved KPS score after shunt surgery, the median postshunting survival was 20.0 months. Postsurgical infection was observed in two cases (6.4%), and shunt revision surgery was required in three cases (9.6%).</p> Conclusions <p>Shunt placement may be considered in selected patients with HGG and CH, particularly those with a positive lumbar tap test and a short interval from KPS decline.</p>