Purpose: To perform a systematic review and meta-analysis to identify predictors of postoperative seizure freedom in patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy. Method: Publications were screened from electronic databases (MEDLINE, EMBASE), epilepsy archives, and bibliographies of relevant articles that were written in English. We recorded all possible risk factors that might predict seizure outcome after surgery. We calculated odds ratio (OR) with corresponding 95% confidence intervals (95% CI) of predictors for postoperative seizure freedom. Heterogeneity was assessed with I-2. All meta-analyses were performed using Review Manager. Results: Epilepsy duration (OR = 2.57, 95% CI = 1.21-5.47, p < 0.05, I-2 = 1%) and ictal or interictal electroencephalographic anomalies precisely localized in the ipsilateral temporal lobe (OR = 3.89, 95% CI = 1.66-9.08, p < 0.01, I-2 = 0 and OR = 3.38, 95% CI = 1.57-7.25, p < 0.05, I-2 = 0, respectively) were significantly associated with a higher rate of seizure freedom after surgery. However, the positron emission tomography (PET) results were not predictive of postoperative seizure freedom (OR = 2.11, 95% CI = 0.95-4.65, p = 0.06, I-2 = 0). No significant difference in seizure freedom was observed between the positive and negative pathology groups (OR = 1.36, 95% CI = 0.70-2.63, p = 0.36, I-2 = 0). Conclusions: A shorter epilepsy duration and scalp electroencephalogram (EEG) signals localized precisely in the temporal lobe predicted a better seizure outcome in patients with MRI-negative temporal lobe epilepsy. (C) 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.