Intracranial Injury Following Nasogastric Tube Placement After Skull Base Surgery: A Case Report and Systematic Review.

Inadvertent intracranial nasogastric tube placement is a recognized risk following skull base fracture, but prior skull base surgery also poses a significant and underrecognized risk for this potentially fatal complication. We report the case of a 75-year-old female admitted with Clostridioides difficile colitis, six months after endoscopic endonasal resection of a pituitary macroadenoma. A systematic review identified 10 prior cases of intracranial tube placement following skull base or sinonasal surgery, including nasotracheal and feeding tube insertions. Literature suggests that using small-bore flexible tubes and preserving anatomical barriers, such as the position of the middle turbinate and intact bony structures like the sphenoid sinus roof, may reduce risk. We aim to characterize the risk of iatrogenic intracranial tube placement through a systematic review and a representative case.