Autologous nerve grafting remains the clinical benchmark for the repair of peripheral nerve injury (PNI), but its widespread application is limited by restricted donor availability, donor-site morbidity, and functional mismatch. Allogeneic nerve grafting introduces additional concerns, including immune rejection and potential disease transmission. Accordingly, tissue-engineered nerve guidance conduits (NGCs) have emerged as promising alternatives for peripheral nerve repair. This review systematically summarizes recent advances in the design and fabrication of high-performance NGCs. We first discuss material-selection principles related to biodegradability, mechanical performance, and cell-adhesive properties, with emphasis on synthetic polymers such as polycaprolactone and natural biomaterials such as silk fibroin and chitosan. We then compare major fabrication strategies, including mold casting, freeze-drying, 3D printing, and electrospinning, highlighting their respective capabilities and limitations in controlling conduit geometry, porosity, micro/nanotopography, and directional guidance. Finally, we summarize functionalization strategies for remodeling the local regenerative microenvironment, including electrical functionalization, anti-inflammatory and antioxidant modifications, and pro-vascularization approaches. Compared with conventional single-layer conduits, multistructured biomimetic NGCs offer greater potential to integrate mechanical support, topographical guidance, electrical regulation, immunomodulation, and vascular support within a single regenerative platform, thereby providing a promising framework for the development and clinical translation of next-generation multifunctional NGCs.