While stem cell transplantation holds promise in preclinical models, clinical applications are limited by concerns over immune rejection, low survival rates of transplanted cells, and the risk of tumor formation. Exosomes, as cell-free therapeutic agents, avoid these complications while retaining the therapeutic benefits of stem cells. Exosomes are more stable in circulation and exhibit reduced immunogenicity, allowing for targeted delivery to neural tissues. This improves the safety and efficacy of regenerative therapies for CNS disorders. Moreover, recent innovations in bioengineering have paved the way for the customization of exosomes for specific therapeutic purposes. By modifying parent stem cells or directly loading exosomes with therapeutic agents, researchers are developing precision-engineered exosomes tailored to specific pathological processes. For example, exosomes can be engineered to carry neuroprotective molecules or anti-inflammatory agents that target distinct disease pathways in Alzheimer's, Parkinson's, or stroke. These bioengineering advancements hold the potential to revolutionize the field of regenerative medicine, offering personalized therapies that address the unique pathophysiological needs of individual patients.