<p>Microneedle-based neural interfaces have emerged as a promising platform for precision neuromodulation and neural monitoring, offering minimally invasive, spatially precise, and multifunctional solutions to address neurological disorders. Combining advances in microscale engineering, biocompatible materials, and digital integration, these interfaces overcome the limitations of conventional techniques by enabling localized delivery of therapeutic agents, high-resolution recording, and modulation of neural circuits. Recent innovations have expanded their capabilities beyond drug delivery to include optoelectronic stimulation, closed-loop control, and biohybrid designs, demonstrating efficacy in preclinical models of peripheral nerve regeneration, stroke recovery, neurodegenerative diseases, and neuro-oncology. This review synthesizes current progress in the design, fabrication, mechanisms of action, therapeutic applications, and translational challenges of microneedle-based neural interfaces. We also highlight emerging trends such as intelligent, multimodal, and patient-centered systems that are poised to redefine the landscape of neurotechnology. By bridging engineering, biology, and data science, microneedle-based neural interfaces hold immense potential to advance next-generation neurotherapeutics, offering precise, personalized, and scalable solutions for restoring and enhancing neural function.</p> Graphical Abstract <p></p>