Epilepsy is a serious threat to the health and life of the patient. If the seizures are not controlled after more than 2 years of regular medication under the guidance of a specialist, it is a refractory intractable epilepsy, and the choice of surgical treatment should be considered. The goal of surgical treatment is to completely control or relieve the seizures. Complete control means that the seizures stop completely without medication, meaning that the seizure-producing tissue is completely removed; remission means that the seizure-producing tissue is not or cannot be completely removed, or the seizure transmission pathways are disrupted, and medication is still required. A comprehensive preoperative evaluation is necessary and critical, including determination of the indications for surgery, feasibility of surgery, choice of surgical approach, and prediction of surgical outcome. This requires a comprehensive assessment of the clinical characteristics of the patient’s seizures, electrophysiological examination (including various EEGs), neuroimaging (CT, MRI, PET, and magnetoencephalography), and neuropsychology to lateralize and localize the epileptic focus, and those who match two or more assessment items are more suitable for surgery. The treatment plan will be formulated after the comprehensive evaluation. Surgery includes anterior temporal lobectomy, selective amygdala hippocampal resection, cortical resection of epileptogenic foci, brain stereotactic surgery, corpus callosotomy, Luan’s thermal cautery, submural transverse fiber cut, cerebral hemisphere resection and chronic neurostimulation. Intraoperative cortical and deep brain EEG monitoring is important to correct the deviation of extracranial EEG and to determine the epileptic foci more precisely. Intraoperative cortical EEG monitoring can effectively avoid missing epileptic foci and assess the postoperative effect, which is also beneficial to improve the surgical outcome. After surgery, the patient should continue to take antiepileptic drugs for a period of time, usually six months to two years, and consider whether to stop or reduce the drugs according to the seizure control. The statistics of a large number of cases show that the cure rate of epilepsy surgery is 60% to 80%, the efficiency rate is 71% to 95%, and the complication rate is about 5%. It is clear that surgery is an effective and safe treatment for refractory epilepsy.