Several key factors need to be taken into account when planning surgery for the treatment of medically refractory epilepsy to ensure an optimal seizure outcome. Thorough knowledge of cortical anatomy, particularly that of the temporal lobe, is essential for the successful identification of epileptogenic tissue during an operation, as well as functional areas of the cortex that are to be avoided to reduce neurological complications. Noninvasive techniques such as seizure semiology, scalp electroencephalography (EEG), magnetic resonance imaging (MRI), positron emission tomography (PET), and magnetoencephalography (MEG) are valuable in identifying the likely seizure onset zone. Combining both knowledge of cortical anatomy and information from noninvasive techniques allows us to accurately deploy intraoperative monitors such as electrocorticography (ECoG) to identify focal epileptogenic tissue. In addition to this, several intraoperative techniques are used in conjunction with ECoG such as cortical stimulation mapping, high gamma field mapping, and high-frequency oscillation analysis to precisely identify areas of eloquence. By considering these factors, the best possible patient outcomes can be achieved.