[Abstract] Objective To investigate the timing of surgical treatment of pediatric drug-refractory epilepsy and the relationship between pathological findings and outcome. Methods Seventy-one cases of pediatric refractory epilepsy were treated surgically with at least 1 year of postoperative follow-up, and the surgical outcome was assessed according to the Engel prognostic grading. Results Of the children with refractory epilepsy followed up postoperatively, 45 (63%) were seizure-free (Engel grade I) and 26 (37%) still had seizures (Engel IICIV). Pathological findings were focal cortical dysplasia in 31 cases, low-grade tumors in 18 cases, scarred gyrus in 13 cases, cerebellar gyrus malformation in 6 cases, and tuberous sclerosis in 3 cases, including dual pathology in 9 cases. There were no surgical deaths or permanent complications. Conclusion Early surgery is a safe and effective treatment for pediatric refractory epilepsy, and there may be a correlation between the type of pathology and surgical outcome. Shan Yongzhi, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University Chinese Journal of Neurosurgery 2014, 9