Anterior temporal lobectomy (ATL) is an effective treatment for drug-resistant epilepsy, and risk for post-surgical naming and verbal memory decline after dominant hemisphere ATL is well-established. However, less is known about later life cognitive and functional outcomes following ATL performed in early or mid-life, as there are few studies that report very long-term outcomes, and the intersection of epilepsy and the aging process is not well-understood. Factors that may promote healthy cognitive aging or confer increased risk for cognitive decline in late life for those with seizure onset in early or mid-life have yet to be determined. This case report describes an individual with drug-resistant epilepsy who was treated with left ATL in mid-life, and then subsequently sustained a moderate traumatic brain injury 22 years later. The excellent recovery and remarkable stability of cognitive performance over time may be associated with several protective factors such as favorable seizure outcome, high cognitive reserve, and the absence of co-occurring medical conditions. This case also highlights the clinical utility of serial neuropsychological testing at multiple timepoints across the lifespan for those with epilepsy, and the importance of considering the clinical significance, or functional impact, of cognitive deficits in this population.