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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\u2010 and postoperative memory performance and intelligence quotient (IQ).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 of postsurgical follow\u2010up with TP\u2010AH (69.5%) and TI\u2010AH (76.7%) as compared to the TU\u2010AH (43.5%) approach (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.03). The number of fibers of the inferior fronto\u2010occipital fasciculus postoperatively was reduced in the TI\u2010AH group compared with the TU\u2010AH and TP\u2010AH groups (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.001). The rate of visual field defects was significantly higher with TI\u2010AH (14\/19, 74%) in comparison to the TU\u2010AH (5\/15, 33%) and TP\u2010AH (13\/40, 32.5%) approaches (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.008). Finally, there was a significant postoperative decline in verbal memory in left\u2010sided surgeries (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.019) and delayed recall for both sides (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001) regardless of the surgical approach. However, TP\u2010AH was the only group that showed a significant improvement in visual memory (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001) and IQ (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001) for both right\u2010 and left\u2010sided surgeries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>The TP\u2010AH group had better short\u2010term seizure control than TU\u2010AH, a lower rate of visual field defects than TI\u2010AH, and improved visual memory and IQ compared to the other groups. Our findings suggest that TP\u2010AH is a better surgical approach for temporal lobe epilepsy with HS than TI\u2010AH and TU\u2010AH.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.16816","type":"journal-article","created":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T23:52:58Z","timestamp":1610754778000},"page":"439-449","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Transsylvian amygdalohippocampectomy for mesial temporal lobe epilepsy: Comparison of three different approaches"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2523-9806","authenticated-orcid":false,"given":"Jo\u00e3o P. S. A. 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