We reviewed the medical records of all patients undergoing anterior temporal lobe surgery for intractable epilepsy from 1988–93 to compare the ictal semiology and operative outcome in patients with intractable partial epilepsy associated with medial or lateral temporal lobe lesions. Forty-one consecutive patients with magnetic resonance imaging (MRI) and pathologically identified temporal lobe lesions were divided into two groups based on lesion location: Group I (medial [ n = 25]) and Group II (lateral [ n = 16]). Complex partial seizures occurred in 92% of Group I and 94% of Group II ( p > 0.05). Generalized tonic-clonic seizures occurred in 16% of Group I and 23% in Group II ( p > 0.05). Auras were present in 76% of Group I and 56% of Group II ( p > 0.05). The specific ictal behavior and interictal-ictal EEG findings were not significantly different in the two groups. The postoperative seizure-free rates were 80% in Group I and 88% in Group II ( p > 0.05) and 83% for both groups combined. We found no differences in the ictal semiology of medial and lateral temporal lobe lesional epilepsy. Both groups experienced an excellent surgical outcome.