Background: The temporal lobe is the most epileptogenic region of the human brain. There are two types of temporal lobe epilepsy (TLE), the medial involves the medial or internal structures, and neocortical involves the outer portion of the temporal lobe. It can be associated with a magnetic resonance imaging (MRI) lesion or be non-lesional. The main causes of lesional TLE are Herpes simplex, benign tumors, vascular malformations, cortical development malformations, and post-traumatic or post-infectious gliosis. Objective: To discuss temporal lobe epilepsy with all its different causes, evaluating different modalities of treatment, obstacles in applying all modalities in developing countries, and ways to overcome these obstacles with future scope of epilepsy treatment especially temporal lobe epilepsy. Patients and methods: The study performed on twenty patients admitted to Al-Hussein and Sayed Galal University hospitals, and Al-Ahrar teaching hospital. There were pre-surgical evaluations by a multidisciplinary team of neurologists, clinical neurophysiologists, neuroradiologist, epileptologists, psychologists, psychiatrists, and neurosurgeons. Most of cases were temporal lobe lesional epilepsy. Surgical management was carried out for the included patients according to present pathology. Results: Our patients' ages ranged from 7 to 55 years old with the mean age of 21.2 ± 13.79 years. 60% were in 2nd decade. 70% of patients were males and 30% were females, 90% were right handed and 10% left handed. The range of duration of the disease was 2-8 years with the mean 4.1 ± 2.125 years. As regard MRI pathological findings; 10% normal, 10% left temporal sclerosis, 10% right insular dysplasia, 5% right temporal encephalomalacia, 10% temporal covernoma, 10% temporal arachnoid cyst, 5% right temporal epidermoid cyst and 40% temporal neoplastic lesions of MRI findings. 55% Left temporal epileptic discharge, 25% right temporal epileptic discharge, 10% bilateral temporal epileptogenic activity with tendency to generalization and 10% normal of EEG. 65% lesional excision, 10% excision and fenestration of cyst to subarachnoid space, 15% amygdalohippocampectomy, and 15% temporal lobectomy. Among the patients surgically operated, 4 patients (20%) had temporarily complications. Conclusion: Temporal lobe epilepsy surgeries provided a good chance for seizure control when the clinical and radiological data were concordant with seizure semiology, in particular with tumor-related epilepsy. TLE surgery can be safe when performed by experienced surgeons.