Background <p>Intracranial sewing needles are an extremely rare neurosurgical condition. Such injuries mostly occur during infancy, with the sewing needle penetrating intracranially through unclosed fontanelles. The clinical manifestations of intracranially retained sewing needles are often insidious and nonspecific. The sewing needle often remains in the brain for prolonged periods until it is discovered in adulthood due to an accidental imaging examination or the appearance of symptoms such as headache and epileptic seizures.</p> Case presentation <p>In this report, an exceptionally rare case of a 47-year-old woman with a sewing needle retained intracranially for more than 45 years since infancy is described. The sole clinical manifestation in recent years was recurrent dizziness. The needle was likely inserted accidentally through the anterior fontanelle during infancy. We performed a microsurgical operation. During the operation, the sewing needle was observed to be completely encapsulated by organized fibrous tissue, forming a fibrous sleeve-like structure that enclosed it. The rusty sewing needle was successfully removed, and part of the encapsulating cyst wall was resected. The patient’s dizziness disappeared after surgery, and no new neurological symptoms were observed during the six-month follow-up period.</p> Conclusions <p>The characteristic presentation of long-term intracranially retained sewing needles may be an organized fibrous capsule. In this specific case, adopting a surgical strategy aimed at removing the sewing needle and debriding the cyst cavity—rather than performing aggressive total resection of the fibrous capsule—is a reasonable approach that balances foreign-body removal with brain protection.</p>