Introduction:\nTemporal lobe epilepsy (TLE) is the most common form of localization-related epilepsy (LRE) in adults accounting for approximately 60-80% of all epilepsy patients. Medial temporal lobe epilepsy (mTLE) is much more common than neocortical TLE, and it means a heterogeneous spectrum of focal seizures that manifest clinically in structures of the medial temporal lobe, it is also known as mesial temporal lobe epilepsy.\nHippocampal sclerosis (HS) is the histological finding we find most frequently in TLE. It is intractable between 50 and 70% of cases. Epilepsy of mesial origin is the most resistant to drugs and represents a challenge for the epileptologist and neurosurgeon.\n\nMaterial and Methods:\nThe design of this study is quasi-experimental, with a process: quantitative, qualitative, as well as a scope: descriptive, exploratory. \nObjective: To determine the hippocampal volumetry based on the degree of hippocampal lesional or non lesional, clinical evolution and socioeconomic data of adult patients suffering from temporal lobe epilepsy, together with imaging studies such as CT, MRI and EEG.\n• Inclusion criteria\n- Patients over 18 years of age with refractory temporal lobe epilepsy.\n- Patients with the use of at least 3 different antiepileptic drugs and without clinical control of TLE.\n- Patients admitted to the HRAEB with TLE and complete clinical file.\n- Patients with complete clinical and imaging studies: CT, EEG, Wada test, (MRI).\nThe software 3D Slicer version 4.2 was used, as well as a manual segmentation of the hippocampus, in addition to the statistical program SPSS\nResults:\nThirty patients (100%) were found, 19 corresponding to female gender (63.3%), and 11 to male gender (36.7%). There is a greater distribution in the female sex of the patients studied. The epileptogenic focus of TLE was identified by EEG patterns in 20 patients (66.7%) in the left temporal lobe, and in 10 patients (33.3%) in the right temporal lobe. \nIn one patient hippocampal atrophy and hyperintensity in the region of amygdala was found (3.3%), in 1 patient hippocampal atrophy was found, increased FLAIR signal and increase the size of the shaft of the temporal region (3.3%). \nWe identified 11 patients who used 3 different antiepileptic drugs -AED- (36.7%), 14 patients used 4 different AED (46.7%), and 5 patients used 5 different AED (16.7%). Regarding the Wada test, the dominance of the Left Temporal Lobe is 20 patients (66.7%) and the dominance of the right temporal lobe is in 10 patients (33.3%).\nThe average of the left hippocampus is 1767.7583 mm3, and 1972.6713 mm3 of the right hippocampus, the median of the left hippocampus is 1746.0265 mm3, and 1900.5010 mm3 of the right hippocampus; the minimum value of the left hippocampus is 932.08 mm3, and the right hippocampus 1264.89 mm3; the maximum value of the left hippocampus is 2373.05 mm3, and the maximum value of the right hippocampus is 2758.52 mm3.\nA Pearson correlation is found between the left hippocampal volume and the right hippocampal volume. \n\nDiscussion: \nIn 17 patients, that is, in 56.1% there is hippocampal atrophy as the predominant finding individually or in combination with other findings, such as hippocampal atrophy together with the increase in the FLAIR signal, or hippocampal atrophy together with the increase in signal in T2, which are essential to identify by the neuroradiologist or neurosurgeon.\nThis volumetric, quantitative information, together with the clinical characteristics - Wada test - and the imaging - described above - allow us to be able to identify with precision, that despite the left hippocampal atrophy in 20 of the patients and the predominance of the Wada in themselves, the hippocampus remains with electrophysiological function, that is with functions (language and memory); and on the other hand, patients where no hippocampal activity is identified, nor the predominance of the Wada test (right hippocampus), the hippocampal resection can be performed, without the risk of causing an injury or leaving the patient with a permanent neurological sequel, such as be the loss of recent or medium-term memory, to mention any of them.\nIn contrast, in patients with a left hippocampal lesion and a predominance of the Wada test, a hippocampal transection (by the neurosurgeon) can be performed, that is, only perform one or several minimum sections, between 2 and 3 mm deep on the hippocampal surface to only partially disconnect that hippocampus and not cause its complete disconnection, in other words, prevent the dissemination of the electrophysiological stimulus, prevent its spread, to prevent the development of an epileptic crisis, which, although, will not completely cease seizures; the frequency and intensity of them will decrease.