The good efficacy of surgical procedures for the treatment of adult epilepsy is well established, and in children with epilepsy, a large body of case data suggests that early surgical intervention may significantly improve the prognosis of the child. The goal of surgery is to stop catastrophic developmental disorders by controlling seizures, and the plasticity of the child’s brain facilitates the return and reorganization of neurological function after surgery. 1. Early detection of drug-refractory epilepsy Early detection of drug-refractory epilepsy allows for surgical decision making. The epileptologist should have an in-depth understanding of the natural course of childhood epilepsy syndromes and must distinguish between self-limiting symptoms, where remission is likely to occur, and refractory cases, where remission is highly unlikely. Some specific epilepsy syndromes, as well as young age of onset, intellectual disability, neurological abnormalities, persistent status epilepticus, multiple seizure types, frequent seizures manifested at the onset of epilepsy, and significant focal EEG abnormalities are risk factors for progression to drug-refractory epilepsy in children. Some children and infants may have epilepsy due to severe congenital anomalies or to diseases that cause progressive neurological dysfunction, such as tuberous sclerosis, Sturge-Weber syndrome, and Rasmussen’s encephalitis. The EEG in children is more complex compared with adults, and even limited imaging changes may show diffuse or multifocal abnormalities. Therefore, advances in neuroimaging are more important for pediatric patients. High-resolution MRI can identify a greater number of abnormalities associated with neuro-migratory disorders. The growing familiarity of clinicians with such lesions has also greatly improved the diagnostic rate. 3. Accumulation of experience in the surgical treatment of infants and children Decades of research and experience have confirmed that the surgical efficacy of epilepsy in children is at least comparable to that of adults. And there are specific epilepsy surgeries that should be used almost exclusively in pediatric patients, such as cerebral hemispherectomy, both anatomic and functional. 4. The risk of epilepsy surgery is not significantly higher in children and infants than in adult patients Childhood is a period of rapid development and great vulnerability and sensitivity, during which seizures and antiepileptic treatment may lead to developmental delays such as functional impairment, activity limitations, medication side effects, school dropout, and reduced socialization. In addition, early surgery reduces the likelihood of exacerbating seizures due to the formation of secondary epileptic foci. Successful surgical treatment provides an opportunity for children with epilepsy, who are in a period of rapid physical and psychological development, to catch up with normal children.