The first selective amygdalohippocampectomies were performed via a transtemporal approach. Later, alternative and technically more demanding routes were described that were claimed to be even “more selective.” Their superiority regarding benefit-risk ratio was, however, not clearly demonstrated in clinical trials. A drawback of the transtemporal approach that must be accounted for is that it regularly causes a contralateral upper quadrantanopia. If, in addition to hippocampus and amygdala, an accompanying epileptogenic lesion in the operculum, insula, or temporobasal region is to be resected, the alternative approaches are preferable.