Background This study was conducted to compare hippocampal volume in patients with TLE with that of a normal control group, and examine the degree and frequency of reductions in hippocampal volume in patients with prolonged epilepsy. Methods This was a hospital based cross-sectional observational study conducted among 228 patients who presented with epilepsy to the Department of Radio-Diagnosis at Ashwini Neuro-Trauma Center Cuttack, from 2015 to 2020 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results Hippocampal volume distribution in the left lobe as well as the right lobe was found to be significantly lower in epileptic subjects as compared to non-epileptic subjects. Using the Mann-Whitney U Test, the mean rank of left and right hippocampal volume comparisons among the group of subjects was found to be statistically significant. There was a significant difference in duration of seizure between epileptic and non-epileptic groups using the Mann-Whitney U test. It was seen that with an increase in seizure duration, there was a decrease in hippocampal volume, both left and right. The correlation was, however, poor but was found to be statistically significant for both left and right hippocampal volumes. Conclusion The ability of volumetric 3D imaging to predict the presence and laterality of hippocampal atrophy plays an integral role in the evaluation of patients with epilepsy, especially in patients with subtle findings and no perceptible hippocampal atrophy on visual inspection and, should be utilized on a regular basis in clinical practice as it is superior to visual analysis in detecting hippocampal atrophy, which can help in guiding surgical resections.