Epilepsy surgery has become an important therapeutic option for children with medically resistant epilepsy. Localization-related seizures with or without secondary generalization are treatable by temporal lobectomy, extratemporal resection, or hemispherectomy, with the choice of procedure dictated by the location and extent of the epileptogenic zone. Extratemporal resections are much more common in children than in adults. Favorable rates of postoperative freedom from seizures are possible in all of the childhood excisional procedures. Although prenatally acquired malformations of cortical development are the most prevalent histologic abnormality in children undergoing resection, in a significant proportion, seizures occur in the setting of recognizable epilepsy syndromes. In contrast, the generalized epilepsies are not amenable to resective procedures. Although experimentally justified, corpus callosotomy is palliative except in some cases of atonic seizures, but other seizure types are unimproved, and ongoing medication is the rule. The preoperative evaluation relies on high-resolution magnetic resonance and functional imaging with single photon emission computed tomography, positron emission tomography, and spectroscopy to help to define the epileptogenic region, especially in extratemporal nonlesional cases. Subdural EEC monitoring often contributes definitive localizing information and facilitates cortical mapping. Earlier surgery improves psychosocial and rehabilitative status, whereas medical intractability predisposes patients to psychosocial deterioration.