Brain necrosis induced by intranasal cocaine in a patient with a history of craniofacial resection: A case report.

A 57-year-old male woodworker was diagnosed with T3N0M0 intestinal-type nasal adenocarcinoma in 2021. He underwent endoscopic craniofacial resection and radiotherapy, with no recurrence for three years. In 2024, he presented with occipital headache and vomiting, revealing a frontal necrotic-hemorrhagic lesion with acute hydrocephalus, initially suspected to be a brain abscess. However, a history of cocaine use suggested brain necrosis facilitated by prior surgery. This unique case demonstrates brain necrosis directly attributable to intranasal cocaine use. Surgeons should consider substance use as a contributing factor in postoperative complications after skull base surgery.