Amygdalohippocampectomy (AH) is a promising treatment option for patients with mesial temporal lobe epilepsy (MTLE). Surrounding temporal lateral, basal, and polar tissue may retain normal function in MTLE. Different approaches to resect the mesial temporal structures have been suggested to minimize damage to the unaffected temporal lobe, with the aim of optimally preserving, e.g., cognitive, memory, speech, or visual function. All approaches to the hippocampus have innate potential risks and side effects. The subtemporal or temporal-basal approach via a small temporal-basal craniotomy is technically demanding, e.g., with large basal veins, in finding and entering a narrow temporal horn, and temporal-basal language areas may be affected. However, its potential advantages are preservation of the temporal stem with relevant fiber tracts, e.g., for frontal lobe connectivity, better preservation of Meyer’s loop and potentially improving visual field outcome, and its distance to the eloquent superior temporal gyrus and its fiber connections. The resection of the amygdala, hippocampus, and parahippocampal gyrus with uncus is basically not different to other approaches to the mesial structures, except for the fact that the different, i.e., more upward oriented angle of approach must be kept in mind.