Post-traumatic epilepsy (PTE) is an epileptiform seizure secondary to brain damage, accounting for 5% of all epilepsies, 20% of symptomatic epilepsies, and up to 34% of epilepsies in patients with wartime craniocerebral injury, which is a huge medical and social problem. There is a lack of effective treatment for PTE, and the vast majority of patients tend to develop refractory epilepsy, mainly because the pathogenesis of traumatic epilepsy is not yet clear. In recent years, many scholars have realized the danger of traumatic epilepsy and focused on the theoretical and clinical research of traumatic epilepsy. We have treated 240 patients with traumatic epilepsy by combining various surgical procedures under intraoperative cortical and deep EEG monitoring since July 2005 with satisfactory results, as reported below. 1. General data (1) Clinical data: 180 males and 60 females; age: 16-45 years, average: 26.8 years; duration of disease: 4-12 years, average: 6.4 years. All of them had a history of craniocerebral trauma, among which 170 cases had a history of craniotomy. All had a history of generalized seizures, ranging from 2 to 3 seizures per month to more than 10 seizures per day. All of them were treated with antiepileptic drugs with ineffective results. (2) Brain electrophysiological examination was performed in 178 cases, and focal waves were found on the background of slow waves, and 54 cases had bilateral diffuse spike, sharp wave or spike and slow integrated wave (both left frontal and right temporal). (3) There were 200 cases with apparently limited cerebral softening foci on CT and MRI, all of which showed different degrees of long T1 and T2 signals on MRI, and 40 cases with clear hippocampal atrophy. (4) Positron emission tomography (PET) has the disadvantage that it is expensive, radionuclides are not easily available, and it has certain damage to human body. Therefore, fewer patients were selected. (1) Case screening Surgery is an effective treatment for intractable traumatic epilepsy. More than half of the patients with traumatic epilepsy can achieve satisfactory results with surgery, but a considerable number of patients may have reduced or disappeared seizures during this period. In general, surgery should not be performed within 3 to 4 years after the first seizure. (2) Surgical method The scalp incision is designed according to the results of preoperative imaging and electrophysiological examination, centering on the softening foci of the brain and taking into account the area of spiking waves, and exposing the cortical tissue with normal imaging but abnormal EEG as much as possible. After the dural incision, the adhesions between the meninges and the scarred brain tissue should be fully released, and the soft meninges should be kept intact; after the adhesions are separated, the cortical electrodes are first used for “carpet” tracing, and deep EEG monitoring of the hippocampus-amygdala on the affected side is routinely performed if the lesion is located in or adjacent to the temporal lobe. The surgery was performed under the microscope, and 70 cases of epileptogenic foci were resected; 121 cases of epileptogenic foci + multiple subpialtransection (MST)/thermal cautery; 42 cases of epileptogenic foci + anterior temporal lobe, amygdala-hippocampus resection + cortical cautery; and 7 cases of corpus callosotomy + MST + cortical cautery. The surgery was not completed until all or most of the epileptiform discharges disappeared within the available electrode probe in the surgical field. All cases were sent for pathological examination after resection of the epileptogenic foci. Postoperatively, routine antiepileptic drug treatment was administered. The results were based on Tan’s classification. 106 cases (44.2%) were satisfactory, 93 cases (38.8%) were significantly improved, 26 cases (10.8%) were good, 8 cases (3.3%) were poor, and 7 cases (2.9%) were no improvement. There was no surgical death in this group. Postoperative pathology: the specimens sent for examination generally showed glial cell hyperplasia in the brain tissue, some nuclei of neuronal cells were solidified and necrotic, some regional neuronal cells were swollen, and iron-containing hemoglobin was deposited with local focal calcification. The incidence of posttraumatic seizures in patients with craniocerebral injury was reported by Rinaldi et al [2] to be 1%-10% in normal patients and 10% in wartime. Rinaldi et al [2] reported that the incidence of post-injury epilepsy in patients with usual craniocerebral injuries was 1-10%, while the incidence of epilepsy in patients with wartime craniocerebral injuries was up to 34%. Therefore, PTE has long attracted the great attention of neurosurgeons. Some patients with PTE can be treated well with drugs, but there are still some patients who cannot control their seizures with drugs and need surgical treatment. The surgical treatment of epilepsy at home and abroad is usually divided into two categories: classical resection of epileptogenic foci and functional surgery to block the propagation pathways of epileptic discharges. Commonly used epileptogenic surgery includes corticotomy, temporal lobectomy, and selective amygdala-hippocampal resection. Functional procedures include corpus callosotomy, MST, and cortical thermal cautery. In some patients with traumatic epilepsy, the epileptogenic foci are often multifocal, and it is often difficult to use only one of these surgical approaches. Therefore, according to the intraoperative ECoG and deep electrode detection results and the propagation mechanism of the spike wave, we select a corresponding procedure or combine several different procedures to treat post-traumatic epilepsy. This will improve the surgical outcome.