Abstract： Objective To investigate the etiology, surgical indications and outcomes of pediatric intractable epilepsy. Method Surgery for 342 pediatric patients with intractable epilepsy between 1989-2007 were reviewed. The etiology was investigated according to the clinical data. Resection of epileptogenic foci or lobe, and/or multiple subpial transection (MST) was followed when a focal epileptic discharge was indicated according to preoperative evaluation and EcoG, but muhilobar resection with MST and/or corpus callosotomy were chosen to deal with hemispheric multiple epileptic foci. Results Malformation of cortical dysplasia was the most important pathology of pediatric intractable epilepsy. Intractable epilepsy syndromes were accounted for 13.5% of all pediatric intractable epilepsy. At follow-up on average 7.5 years after surgery,158 patients(45. 9%) had an Engel Class Ⅰ outcome after surgery and an additional 76 patients (22. 2%) had rare seizure (Engel Class Ⅱ), and 61 patients had a decrease in seizure frequency (Engel Class Ⅲ). Mean IQ improved from 69. 2 to 79. 8. Temporary complications were observed and there was no death. Conclusions Early surgical intervention in intractable pediatric epilepsy provides the good opportunity to control the seizure, prevent irreversible worse of intelligence. Imbecile IQ should not be a contra-indication of pediatric surgery. Understanding the etiology and pathology of pediatric intractable epilepsy will facilitate the surgery of pediatric epilepsy.