The diagnosis and treatment of recurrent nasopharyngeal carcinoma (rNPC) is challenging. Traditionally, radiotherapy is the most commonly used treatment for rNPC. With the deepening of research on skull base anatomy and the development of endoscopic skull base surgery, surgery has gradually become the mainstream treatment for rNPC. However, due to the complexity of the rNPC disease itself and the importance of the surrounding anatomical structures, its surgical treatment still has a relatively high risk. This article elaborates on the diagnosis, radiotherapy and chemotherapy, surgical treatment and related complications of rNPC.