We investigated the short and long-term outcome of 260 patients after extratemporal epilepsy surgery with a follow-up period of up to fourteen years. Regarding the long-term outcome, 50% of our patients became seizure-free. In 20% of all patients antiepileptic drugs were successfully withdrawn. Approximately 75% of our patients remained in the category of the Engel classification, which they were allocated to directly after surgery, for the whole follow-up. If the patient was seizure free at 2-year follow-up the probability to continue seizure free reached was 85% (95% CI 80–90) up to 10 years. Seizure remission predicted by presence of well-circumscribed focal lesions on preoperative MRI. Seizure relapse predicted by incomplete resection of lesion, presence of IED in EEG postoperative and the need to invasive evaluation of the patients. Extratemporal epilepsy surgery in current stat should depend on restrictive selection for patients to get a successful outcome. The aforementioned information may be important in the decision-making process regarding referring to operation and tapering of anticonvulsant medications postoperatively.