Brain-computer interface (BCI) is gradually entering the clinical transformation stage from laboratory verification. Different from general medical devices, BCI is directly connected to neural activity and external devices. Its clinical value depends not only on signal acquisition, decoding accuracy and functional output, but also on whether patients can obtain clinical benefits that are sustainable, affordable and in line with life goals. Based on the clinical practice of neurosurgery, this paper focuses on the clinical application progress of BCI in the fields of motor function, communication and neurorehabilitation, analyzes the practical difficulties such as long-term safety, indication selection, postoperative rehabilitation and follow-up, efficacy evaluation and multidisciplinary collaboration, and then discusses the ethical and social challenges of informed consent, personality identity and neuroautonomy, neurodata privacy, responsibility attribution and fair access. This paper proposes that the clinical evaluation of brain-computer interface should be shifted from the technical feasibility to the clinical benefits that patients attach importance to, supported by continuous informed consent, full-cycle risk assessment, patient-reported outcome-oriented efficacy evaluation, multidisciplinary long-term follow-up and whole-process ethical evaluation. For neurosurgeons, what is really important is not just to complete a surgical implantation, but to answer at each key decision-making node what this technology has brought to the patient.