For patients with drug-resistant epilepsy, surgery soon after failure of 2 antiepileptic drug (AED) trials is more effective than continued medical management in controlling seizures and improving quality of life. Epilepsy surgery has been underused and should be considered in drug-resistant patients. Patients with drug-resistant epilepsy should be promptly referred to a comprehensive epilepsy center to determine whether they are likely to benefit from epilepsy surgery. Improving the safety and effectiveness of resective surgery for epilepsy requires increasingly precise mapping of cortical function and epileptogenic cortex and networks. The standard techniques commonly used in presurgical evaluation are structural MRI with epilepsy protocol, interictal and ictal SPECT, PET, scalp and intracranial electroencephalograph (EEG), and cortical stimulation. Recent advances in functional imaging and neurophysiology promise to transform the landscape of presurgical evaluation and planning. Some of the new advances in imaging include characterization of resting-state functional magnetic resonance imaging (fMRI), connectivity, tractography, task-specific fMRI for language and memory, EEG source localization (ESL) and integrated EEG–fMRI coregistration provide new ways of mapping cortical function and planning surgical resection. These techniques might be help to reduce an invasive procedure. The long-term outcome of epilepsy surgery in TLE with reported an overall seizure-free rate of 48%, sustained improvements in quality of life, and employment. Early surgery is proven effective in mesial TLE. Although outcomes after extratemporal surgery (ETS), which are heterogeneous, have variable outcome, with seizure-free rates ranging from 27 to 46%. However, most of the cases still get the benefit from epilepsy surgery. Major complications are infrequent after epilepsy surgery and tend to be temporary or limited in their symptomatology.