Whilst much is known about the neuropathological consequences of hydrocephalus, there have been comparatively few studies of the cognitive impairments associated with it. Studies using standardised tests of cognitive function have identified a general pattern of impairments, with patients exhibiting particular difficulty on tests of spatial memory and executive function. A strong prediction is that these deficits are likely to affect daily wayfinding behaviour, and we report a study of spatial and navigational abilities in a group of patients with hydrocephalus but without spina bifida. Participants completed a range of experimental tasks assessing spatial cueing behaviour, landmark memory and route-learning, and idiothetic path integration. This patient group was compared to a control sample matched on verbal, spatial, and intelligence measures, and hydrocephalus was found to be associated with relative impairments in each of the tasks. Patients exhibited reduced sensitivity to spatial cueing, less accurate route-learning, poorer memory for landmark objects, and less accurate spatial updating (with particular impairments in the calculation of heading). Overall, these data represent the first empirical demonstration of navigational impairments in hydrocephalus, and we suggest some of the cognitive, neural, and individual differences factors that may contribute to the pattern of performance reported.