Epilepsy is the only chronic neurodegenerative disorder that can be cured with surgery. Epilepsy surgery encompasses both curative and palliative procedures. Curative surgeries are based on the removal of a focal area of the brain from which the epilepsy arises. Often, this region can be visualized on magnetic resonance imaging (MRI) but is not apparent macroscopically in the operating room. Furthermore, stereotactic navigation in the operating room that is based on a preoperative acquired dataset does not account for intraoperative “brain shift” because of gravity, loss of cerebrospinal fluid, and retraction. MRI can be a useful adjunct for intraoperative neuronavigation in these situations to assure complete removal of the lesion. Surgeries such as amygdalohippocampectomy, functional hemispherectomy, and corpus callosotomy require a complete removal or disconnection of an anatomic structure in the brain. Intraoperative judgment can sometimes be inaccurate in assuring that all operative goals are met. The incorporation of intraoperative MRI scans, combined with neuronavigation, plays a pivotal role in validating or guiding the surgeon’s assessment of various anatomical boundaries. Yet, it remains to be determined whether the adoption of intraoperative MRI is cost-effective and whether it significantly impacts patient outcomes, making it a subject of ongoing investigation.