Tissue engineering is an alternative medical approach to reconstructing neuronal injuries. Topographical features direct neuronal responses, such as cell adhesion, proliferation, morphological changes, alignment, and gene expression, which are controlled by the size, shape, and pattern of the adherent surface. Several studies have reported different aspects of neuronal behavior on aligned micro/nanopatterns and pillars. In this review, we focus on the recent progress in the development of topographical patterns for neuronal outgrowth, guidance, and differentiation. We discuss the neuronal responses to various patterns, such as grooves, fibers, and pillar patterns. These topographical features induce neuronal alignment and enhance their differentiation. Furthermore, we review the underlying mechanisms linked to the effects of micro- and nanopatterns.