The variants of the lateral approach all use the peri-insular sulcus and the lateral ventricle as the access route to isolate the diseased and epileptic hemisphere. The lateral approach does not differ from the vertical approach in terms of seizure control, functional outcome, and complications. Hemispheric atrophy and ventricular dilatation facilitate the procedure and allow a small craniotomy. In the case of hemimegalencephaly, the transsylvian keyhole approach is less suitable.