Background Anterior temporal lobectomy (ATL) is the most common surgical treatment for temporal lobe epilepsy (TLE),although long-term prognosis is often less favorable than short-term outcomes.This study aimed to examine the outcomes of patients with TLE 5 years after undergoing ATL,and to seek possible predictors of prognosis.Methods We examined the clinical records of 121 patients with TLE who underwent ATL in our institution between January 2005 and December 2008.The Engel seizure classification was used to divide patients into seizure free and non-seizure free groups.Univariate and multivariate Logistic regression analyses were used to identify potential prognostic indicators,including history,clinical features of seizures,and magnetic resonance imaging (MRI) and videoelectroencephalography (EEG) findings.Results The majority of patients were seizure free during the follow-up period:71.9％ 1 year after surgery; 71.6％ after 2 years; 75.8％ after 3 years; 78.8％ after 4 years after surgery and 68.8％ after 5 years.There were significant differences between seizure-free and non-seizure-free groups in terms of preoperative seizure duration,history of febrile seizures,type of seizure,and MRI and video-EEG findings (P ＜0.05),but not in terms of sex,age at seizure onset,age at surgery,side of surgery,auras,family history of seizure,or history of traumatic brain injury,perinatal anoxia or intracranial infection history (P ＞0.05).Multivariate Logistic regression analysis showed that a preoperative seizure duration ＜10 years,a history of febrile seizures,simple complex partial seizures,positive MRI findings,hippocampal sclerosis and unilateral localized video-EEG spikes predicted better outcome (P ＜0.05).Conclusions ATL appears to be an effective means of treating TLE.Patients undergoing ATL for TLE require careful and comprehensive assessment to ensure optimal outcomes and to allow patients to make informed decisions about their treatment.