Objective To explore the efficacy of metagenomic next-generation sequencing (mNGS) technology in the diagnosis of nervous system infections and its guiding role in precise medication. Methods A total of 144 patients with suspected postoperative nervous system infections were enrolled and randomly divided into an experimental group and a control group. The experimental group underwent pathogen detection using mNGS technology, while the control group underwent traditional cerebrospinal fluid culture. Clinical data， test results， and treatment outcomes were collected and comparatively analyzed.Results The detection rate of pathogens by mNGS was significantly higher than that by bacterial culture (73.85% vs58.46%， P<0.05)， and mNGS could cover a wider range of pathogen species, including bacteria， fungi， and parasites. Patients in the experimental group were able to adjust their anti-infective treatment regimens more quickly based on mNGS results， thereby improving prognosis.Conclusion mNGS technology exhibits high sensitivity and specificity in the diagnosis of nervous system infections and can guide precise medication， improving treatment outcomes