Epilepsy surgery is an option for many pediatric patients diagnosed with intractable seizures. Identifying pediatric patients that are candidates for surgery can be complicated. This case presented a 19-year-old female with intractable epilepsy who had chronic immune thrombocytopenic purpura and Dandy-Walker variant. The patient had previously been prescribed three appropriate anti-epileptic drugs and continued to experience seizures weekly. The patient had thrombocytopenia, which represented a potential for increased complications. The pre-operative work-up demonstrated heterotopias and dysplasias, which were felt to be the source of the focal onset seizures. She underwent focal resection and at the time of the last follow-up visit, the patient had been seizure free for 2 yr. The outcome of the patient exemplified the importance of evaluating patients with posterior fossa abnormalities for epilepsy surgery. The data in patients with Dandy-Walker variant is limited.