In this review, we discuss the important pathological lesions observed in temporal lobectomies and neocortical resections performed for medically refractory seizures in children. A higher percentage of pediatric cases appear to be "lesional" with computed tomography (CT) and magnetic resonance imaging (MRI) and abnormalities and "dual pathology" lesions appear to be more common than pure mesial temporal sclerosis. Almost a third of cases appear to be neuronal migration disorders and low-grade gliomas with some lesions harboring both neoplastic and malformative components. Our experience suggests a role for cytomegalovirus in some cases of Rasmussen's encephalitis.