© Oxford University Press, 2014. All Rights Reserved. As long as valid assumptions can be made about a focal source, MEG can transform the challenge of EEG based 2D inference of lateralization or regional localization to 3D sublobar indication of epilepsy-related spike generators. As such MEG spike source imaging provides a unique tool for targeting epileptogenic tissue for the surgical treatment of epilepsy. This information can be particularly valuable for patients with neocortical epilepsy in whom intracranial EEG (icEEG) investigations are commonly necessary. MEG localization of spikes may provide more accurate electrode sampling of the cortex responsible for seizures, and as a result, increase epilepsy localization and surgical resection accuracy. Combined with mapping of eloquent cortical function, MEG can play a role in multiple aspects of the preoperative (non-invasive) decision-making- potential to improve (1) patient selection, (2) ICEEG yield, and (3) increase the net number of seizure-free outcomes. Work remains to determine the validity of variousanalysis methods (stratified on different types of spike sources), and the cost effectiveness of MEG in epilepsy surgery, but it can be concluded that any patients able to proced to surgery that otherwise would not without MEG would contribute evidence to added clinical utility even if the cure rate is unchanged.