**5. Surgical approaches and techniques**

Surgery is an effective procedure for many patients with drug-resistant epilepsy (DRE). Unfortunately, surgery is underutilized; in the USA, <1% of patients with DRE are referred to epilepsy centers [45]. The common reasons for rejections include fear of complications, expenses, reservation about benefits, and misconceptions held by non-specialist physicians [6, 45]. The delay from onset of epilepsy to surgery averages >20 years resulting in impaired social and educational development [8]. Early surgery provides the best opportunity for seizure remission minimizing adverse social and psychological consequences and premature death [6].

Surgical therapy can eliminate disabling seizures completely in appropriately selected patients [46]. Multiple surgical procedures, including recent minimally invasive procedures, are now offered depending on the type of epileptic seizures and their presumed underling pathology (**Table 3**).
