Objective To compare the application effect of anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy via subtemporal approach (SAH) under the cortical electroencephalogram monitoring on patients with medial temporal lobe epilepsy， and the influence on postoperative complications and neuropsychology.Methods The clinical data of 98 patients with surgery for medial temporal lobe epilepsy from January 2010 to June 2019 were retrospectively analyzed. According to the different surgical methods， the patients were divided into ATL group (53 cases) and SAH group (45 cases).The perioperative indexes and postoperative complications were compared between the two groups. At 1 year of follow-up after surgery， the epilepsy control status was statistically analyzed in the two groups according to the Engel’ s classification. Wechsler Adult Intelligence Scale (WAIS-RC) and Wechsler Memory Scale (WMS) were used to evaluate the influence of surgery on neuropsychology of patients.Results There were no significant differences in the surgical time， intraoperative blood loss ratio， postoperative hospital stay and postoperative medication status between the two groups (P>0.05). The total incidence rate of postoperative complications in ALT group was higher than that in SAH group (18.87% vs 4.44%) (P<0.05). At 1 year after surgery， there was no significant difference in the Engel’ s classification of epilepsy control between the two groups (P>0.05). There was no significant difference in the total effective rate between ALT group and SAH group (94.34% vs 91.11%) (P>0.05). At 1 year after surgery， there were no significant differences in the PIQ， VIQ and FIQ of WAIS-RC scale and MQ and VM of WMS scale in ALT group compared with those before surgery (P>0.05)， but the VIQ and MQ in SAH group were significantly higher than those before surgery (P<0.05)， and the VIQ and MQ were significantly higher than those in ALT group at the same time point (P<0.05).Conclusion Both ATL surgery or SAH surgery via subtemporal approach can better control epileptic seizures in the treatment of medial temporal lobe epilepsy. However， SAH surgery via subtemporal approach has positive significance in reducing the risk of postoperative complications and improving postoperative language intelligence quotient and memory quotient.