Anterior temporal lobectomy (ATL) is a surgical procedure used in the treatment of medically refractory temporal lobe epilepsy (TLE). It is a method used to improve the quality of life of patients who do not respond to medical treatments at the desired level. The temporal lobe, especially the mesial structures, is a region where epileptogenic foci are common. Therefore, ATL plays a critical role in the surgical management of epilepsy. ATL is also applied in cases other than epilepsy, such as temporal lobe tumors, vascular malformations, and other pathologies where resection of the anterior temporal lobe is deemed necessary. Before deciding on ATL, a comprehensive evaluation, including detailed clinical assessment, neuroimaging, and electrophysiological studies, is required to ensure precise localization of the epileptogenic zone and minimize postoperative deficits. Surgical technique in ATL usually involves resection of the anterior part of the temporal lobe, which includes the amygdala and hippocampus. Dissection must be performed very carefully to preserve critical neurovascular structures, and intraoperative neuromonitoring must be used to minimize complications during resection. The success of ATL depends on the surgeon’s knowledge of the complex temporal lobe anatomy and surgical experience. Despite the clinical success of ATL, its potential complications require extensive preoperative evaluation and postoperative management. Common complications include neurocognitive deficits, visual field defects, and psychiatric symptoms. This chapter aims to provide a comprehensive overview of the indications, surgical technique, and potential complications of ATL.