Radiation-induced skull base necrosis (RISBN) is a severe and life-threatening late complication following radiotherapy for nasopharyngeal carcinoma (NPC). With the widespread application of intensity-modulated radiation therapy (IMRT) and the prolongation of patient survival, its clinical significance has become increasingly prominent. Based on the latest clinical evidence and guidelines, this article systematically reviews the epidemiology, pathogenesis, and diagnostic and therapeutic progress of RISBN. The core content highlights that quantitative staging and classification systems based on anatomy and imaging (such as the RIEVN staging system) provide a critical basis for individualized treatment decisions; a comprehensive surgical strategy centered on endoscopic radical debridement combined with pedicled vascularized tissue flap reconstruction can effectively improve symptoms and survival rates; the risk assessment and protection of the internal carotid artery (ICA) serve as the pivotal link in determining prognosis; and the multidisciplinary team (MDT) collaborative model constitutes the cornerstone of optimized patient management. This article aims to provide a reference for the standardized and precision-based diagnosis and treatment of this complex complication.