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This study's objective was to compare the transinsular (TI‐AH), transuncus (TU‐AH), and temporopolar (TP‐AH) amygdalohippocampectomy approaches regarding seizure control, temporal stem (TS) damage, and neurocognitive decline.

We included 114 consecutive patients with unilateral hippocampal sclerosis (HS) who underwent TI‐AH, TU‐AH, or TP‐AH between 2002 and 2017. We evaluated seizure control using Engel classification. We used diffusion tensor imaging and postoperative Humphrey perimetry to assess the damage of the TS. We also performed pre‐ and postoperative memory performance and intelligence quotient (IQ).

There were no significant differences in the proportion of patients free of disabling seizures (Engel IA+IB) among the three surgical approaches in the survival analysis. However, more patients were free of disabling seizures (Engel IA+IB) at 2 years …