Purpose <p>In this study, we aimed to define the scope of paediatric epilepsy surgery performed in Asia and Australasia.</p> Methods <p>Representative surgeons from each county were emailed a survey about paediatric epilepsy surgery as it is practiced in their country. The survey covered topics including what investigations, operations and number of surgeries are performed and by whom (adult or paediatric neurosurgeons).</p> Results <p>Epilepsy surgery programmes are for the most part more common in larger countries and countries with a higher gross domestic product (GDP). Countries performing epilepsy surgery commonly have access to the full range of investigations except magneto-encephalography (MEG). Intraoperative electrocorticography (ECOG) and stereotaxy are typically available and most have access to extra-operative monitoring. There is limited availability of laser interstitial therapy (LIT) and responsive neuro-stimulation (RNS).</p> <p>China performs approximately 4000 paediatric epilepsy cases per year which is more than all of the other countries combined. Epilepsy surgery case numbers range from 0.2 to 22/ million population per year, and there is a correlation between the number of cases performed and the countries’ GDP. A large number of children have no access to epilepsy surgery.</p> Conclusion <p>There is a wide variation in access to epilepsy surgery in Asia and Australasia. Some counties have surgical numbers comparable with high volume Western countries, while hundreds of millions of children have no access to surgery at all.</p>