In 1975 Falconer has applied temporal lobectomy for the treatment of complex partial epilepsy in children to control seizures for neurological development. However, the selection criteria for pediatric epilepsy surgery are still not fully defined. In 70% to 80% of epileptic patients, seizures can be controlled or reduced with systematic and rational medication, and the prognosis is good, but some scholars believe that surgery should be performed only when medication is ineffective for more than 2 to 3 years; the site and form of pediatric epilepsy can change continuously with age and brain development, and is fixed at the age of 14 years, plus some pediatric epilepsy has been observed to remit spontaneously during adolescence. The age of 14 years or older has been suggested as the appropriate age for surgery. The treatment of pediatric refractory epilepsy should be fully aware that pediatric epilepsy is different from adult epilepsy: ① etiology and pathological features: pediatric refractory epilepsy is mostly due to birth injury, febrile convulsion brain damage, cerebral hypoplasia, tuberous sclerosis, arachnoid cyst, dermatomal cyst, and congenital malformation. In contrast, adult epilepsy is mostly formed by temporal lobe sclerosis, traumatic brain injury, cerebral softening foci, glioma, gliosis, etc. ② Neuropsychological features: most feel varying degrees of fear of seizures, depressed mood, low self-esteem, cognitive dysfunction, memory loss, and inability to concentrate on learning. Pediatric epilepsy is highlighted by intellectual developmental impairment, the cause of which may be related to primary brain damage, recurrent seizures leading to cerebral hypoxia and cerebral edema. The earlier the age of onset, the longer the duration of the disease, and the later the treatment, the more severe the intellectual impairment. In addition, the use of antiepileptic drugs for seizure prevention and control undoubtedly helps to protect intelligence, but the damage to intelligence caused by their toxicity over time is often overlooked. The lack of folic acid, tryptophan and 5-hydroxytryptophan caused by the drugs leads to suppression of brain development and mental retardation; the impact on hormone levels leads to impairment of neuropsychological functions. The routine administration of antiepileptic drugs for 2 years after epilepsy surgery can be phased out, even if the dose can be reduced, and surgical treatment of pediatric refractory epilepsy is undoubtedly beneficial in terms of reducing the damage to intelligence and long-term economic considerations. The timing of surgery for pediatric refractory epilepsy should not be limited to a minimum age. Ninety percent of human brain development and maturation occurs around age 5, with peak synaptogenesis at age 7-8 and maximum cortical plasticity, followed by a period of selective synaptic degeneration to modify the nervous system until a plateau is reached at age 14. In juvenile cats, hemispherectomy is performed and anatomical regeneration and resulting recovery of sensory and motor function is observed. In humans, brain surgery is performed before the age of 8 to 9 years, and the younger the age, the better the recovery of sensory and motor deficits, indicating that early surgery of the immature brain may lead to recovery of neurological function after development due to high brain plasticity, etc. The results of pediatric epilepsy surgery are often better than those of adults, and because seizure damage to the immature brain is more severe than that of the mature brain, early surgery for pediatric refractory epilepsy should be emphasized to minimize seizure damage to the brain during the critical developmental period and to take advantage of the time when the brain is still plastic to maximize functional recovery. In addition, it is important to differentiate epilepsy in detail. Epilepsy with pathologic changes that are difficult to control medically, such as dysplastic lesions (including macrocephaly, microcephaly, vascular malformations, and arachnoid cysts), Rasmussen’s encephalitis, focal scarring, gliomas, and malformations, does not have to wait for medication to fail before considering surgery. In children with similar pathological changes, the disease is more severe and the surgical results are better than those without clear pathological changes; severe and frequent seizures such as infantile severe clonic epilepsy and Lennox-Gastaut syndrome, which cannot be controlled with two to three most appropriate antiepileptic drugs, are unlikely to be controlled by drugs, so there is no need to try other drugs and surgical treatment should be performed as early as possible. Early and aggressive surgical treatment of pediatric refractory epilepsy can effectively control or reduce seizures, mitigate damage to the brain during the critical developmental period, and take advantage of the plasticity of the developing brain to achieve maximum functional recovery so that the quality of survival can be improved early.