Surgical management of the patient with refractory epilepsy: recent advances. Recent advance in surgical treatment of the patient with refractory epilepsy (RE), and especially in patients with neocortical epilepsy, is reflected by the decrease in the mortality and morbidity and the improved outcome. We tried to review recent publications in order to examine the recent trends and advances in management of RE patients. Among the recent review articles and original articles, those that describe the outcomes in children with RE were more commonly cited than those that discuss RE in adults. The most notable improvements are likely to be: 1) identification of brain malformation as a poor prognostic factor for RE; 2) precise preoperative localization of epileptogenic focus; 3) identification of ictal EEG pattern as an indicator of surgery; 4) reduction of the surgery related morbidity; 5) introduction of the surgical treatment for RE related to neurovascular events; 6) identification of focal cortical dysplasia (FCD) type IIB as a unique subtype of FCD with poor surgical prognosis. The number of major studies in RE is increasing in the last few years. Our ability to make an accurate localization of epileptogenic focus using sophisticated preoperative neuroimaging and EEG would contribute to making more surgical decision of RE. Accurate localizing techniques help improve the outcomes of RE patients by avoiding unnecessary operations and the over-resection of patients with small epileptogenic focus. Additional studies will be needed to determine the true efficacy of the surgery for neocortical epilepsy. The role of surgery in epileptogenic FCD still needs to be investigated. There is a need for developing a new classification of epilepsy in order to better assess the surgical efficacy of RE.