AbstractObjective: To investigate surgical prognostic factors in order to establish a surgical plan for children with drug‐resistant epileptic spasms.Methods: We retrospectively analysed 64 children with drug‐resistant spasms who were operated on in Beijing; the electroclinical features, surgical procedures, and surgical outcomes of these children were discussed in detail. We divided the seizure‐free patients into several groups according to imaging, aetiology, and application of stereo‐electroencephalography in order to investigate the extent of the various influencing factors.Results: Fifty‐three (82.8%) patients had favourable outcome, and 11 (17.2%) had unfavourable outcome. Based on the univariate analysis, the factors associated with favourable seizure outcome were interictal high γ frequency (χ 2 = 4.161; p = 0.041), concordance between MRI and interictal epileptic discharges (IEDs) (χ 2 = 6.148; p =0.013), and concordance between PET and IEDs (χ 2 = 4.281; p = 0.039). Concordance between MRI and IEDs (OR = 0.083, 95% CI = 0.014–0.483; p = 0.006) and continuous discharges on electrocorticography (OR = 0.109, 95% CI = 0.019–0.639; p = 0.014) were important factors associated with a favourable surgical outcome.Significance: Resective surgery is an effective treatment for drug‐resistant ES in children. A deeper understanding of the predictors of seizure outcome is beneficial for establishing a standard, one‐stage resection procedure for spasms in order to benefit more patients who have not previously considered surgery. We propose a workflow for presurgical evaluation in children with epileptic spasms.