Hippocampal sclerosis is the most common cause of mesial temporal lobe epilepsy. Anterior temporal polar focal cortical dysplasia is often missed on a routine MR protocol. A 3T MR imaging is necessary with an experienced MR radiologist. Diffuse cortical dysplasia and severely sclerotic hippocampus can pose surgical challenge. A Standard but extended anterior temporal lobectomy is appropriate in the Indian subcontinent due to various cultural and socioeconomic considerations. Comprehensive epilepsy care team in a tertiary care academic is paramount for the success of the epilepsy care program.