Epilepsy surgery has been developing rapidly in China in the last decade, and now there are various “epilepsy centers” springing up. In China, epilepsy surgery was once rejected and resented due to the lack of understanding of this technology at the beginning and the excessive pursuit of economic benefits by individual hospitals. In recent years, epilepsy surgery has gradually started to become standardized, and domestic neurologists have gradually begun to accept recognition of it and actively participate in the surgical evaluation process. First, patients should exclude epilepsy caused by progressive diseases, such as metabolic abnormalities (e.g., mitochondrial encephalopathy), degenerative diseases (e.g., frontotemporal dementia) Epilepsy syndromes due to genetic factors that are not suitable for surgery (Dravet syndrome, etc.), or benign epilepsy in children that can resolve spontaneously (BECT, etc.). Patients with limited lesions that are not well controlled by medication and have clear indications for surgery, such as temporal lobe epilepsy with hippocampal sclerosis, cortical dysplasia (common focal cortical dysplasia), spongiform hemangioma, neurodevelopmental tumors. In patients with drug-resistant epilepsy for these reasons, or with well-controlled medications but significant side effects (e.g., drowsiness due to carbamazepine, impaired intelligence due to Toltea, mood swings due to Keplar, weight gain due to Depakene, etc.), I will often aggressively recommend surgery (even if they initially reject this option). The premise for surgery is usually drug-resistant epilepsy that is not controlled by 2 and more drugs. It is worth noting that a number of patients come in for surgery because they do not want to take their medications. Although a significant proportion of patients in #2 are able to discontinue their medications for some time after surgery, at least half of them still require long-term medication to control their epilepsy. This is because the lesion seen on the MRI may be small, but the lesion causing the epilepsy may be more widespread, and surgery removes the “worst” part of the brain, but the rest of the “worse” part still needs medication to suppress it. The more extensive the surgical resection, the better the outcome, but the more significant the functional impairment. There is no evidence that surgery is better than medication for epilepsy that is better controlled by medication. Therefore, the first goal of epilepsy surgery is seizure control, not drug withdrawal. This is increasingly recognized by the academic community. Is surgery worthwhile for patients who do not have a clear lesion on magnetic resonance? The surgical treatment of patients with MR negative (“non-focal” epilepsy) epilepsy is a difficult task, and only a few comprehensive epilepsy centers in Europe and the United States are capable of performing it, and not many hospitals in China are able to perform it in a standardized manner. First of all, a subset of patients can be scanned with high-resolution MRI (epilepsy sequences) in combination with functional imaging (e.g., PET, seizure SPECT) to detect a very small lesion. This lesion can be selected for direct resection surgery if it fits well with the patient’s seizure presentation; some patients need the option of intracranial EEG for precise localization of the seizure focus or confirmation of the seizure origin before deciding whether to do resection surgery and the area of resection. Our team has been progressively working on resection of epileptogenic foci with subtle lesion and surgical treatment of patients with completely negative MRI in the last 2 years. (3) The medical surgeon agrees on the surgical resection plan, and the neurosurgeon ultimately performs the precise epileptogenic zone resection.