Introduction: Since 1992, invasive video-EEG monitoring is available at the Reference Center for patients with refractory epilepsy included in the pre-surgical evaluation protocol. In case of discongruent non-invasive findings, video-EEG monitoring with subdural and intracranial depth electrodes is mandatory to precisely localise the ictal onset zone and to map surrounding functional cortex prior to resective or disconnective surgery. Methods: Data from all patients who underwent invasive video-EEG monitoring were reviewed to evaluate different therapeutic interventions that were subsequently performed. Treatment efficacy was assessed after long-term follow-up. Results: Since 1992, 71 patients underwent invasive video-EEG monitoring. 34/71(48%) patients underwent resective surgery (RS) of whom 23 became seizure-free; in 5/23 AEDs were completely tapered. 24/71 patients were treated with either multiple subpial transsections (MST) (2), a combination of MST and RS (3), vagus nerve stimulation (VNS) (8) or continued AED's without surgical intervention (11). In these 24 patients, seizure-freedom was obtained in 1 patient with MST, in 2 patient with MST+RS and in 1 patient with AEDs. 13/71 patients received hippocampal deep brain stimulation (DBS) of whom 3 became seizure-free; in 5/13, 1 AED could be stopped. Conclusion: Depending on the results of the invasive video-EEG monitoring, different treatment options were offered. In 50 % of patients RS was a treatment option. 2/3 of patients who underwent RS following invasive recording became seizure free. Other treatment options included MST, DBS and VNS. 10 % of patients remained on AED treatment only.