Anterior temporal lobectomy (ATL) was first introduced by Penfield in the 1950s in order to treat psychomotor epilepsy. Later in 1956, Paulo Niemeyer described his pioneer experience of selective amygdalo-hippocampectomy (sAH) in a letter to his epileptologist friend Gastaut: To treat psychomotor epilepsy patients, he used a “trans-ventricular” surgical technique to resect the mesial temporal lobe structures (MTLS) of “nucleus amygdalae, in Ammon’s horn, or in the hippocampus of gyrus” while preserving the neocortical temporal lobe but resulting in good surgical outcome [1]. The surgical approach has since evolved over time to the currently well-acknowledged standard ATL which includes resection of both lateral and MTLS, with the latter being mostly the hypothesized epileptogenic focus [17, 18, 20]. Different from classical frontal-temporal approach incision, our team routinely uses a modified mini-temporal approach for anterior temporal lobectomy or trans-cortical sAH in tumor or epilepsy surgeries (Fig. 15.1). This approach shows advantages in shortening operating time, lowering cortical injury, complete restoration of temporalis to improve cosmetic outcome and protection of facial nerve [10] (Figs. 15.2, 15.3, 15.4, 15.5, 15.6, 15.7, 15.8, 15.9, 15.11, 15.12, and 15.13). It is reasonable to develop selective surgeries to resect MTLS without or minimize the injury to lateral cortex. Traditionally, the surgical strategies to this region can be classified as trans-cortical (TC) (Figs. 15.11, 15.12, and 15.13), trans-Sylvian (TS), and sub-temporal (ST) approaches, constituting the lateral approach. The TC approach has similarities with the very first “trans-ventricular” pathway reported by Niemeyer. More recently, posterior approaches including the supracerebellar transtentorial (SCTT) and infraoccipital supratentorial (IOST, Figs. 15.14, 15.15, 15.16, and 15.17) have been demonstrated by several neurosurgical centers, enriching the surgical options to the MTLS region.