This retrospective study analyzed whether pre-operative MRI and EEG findings predict seizure outcomes following epilepsy surgery. Fifty patients were evaluated using extracted surgical notes, imaging reports, Engel scores at 1, 2, and 5 years, and recurrence data. MRI features were categorized by laterality, lesion location, and lesion type, while EEG findings were classified by seizure pattern. Results showed that patients with normal pre-operative MRIs were more likely to require repeat surgery and had worse long-term outcomes. Lesion locations and categories showed variability over time, and EEG patterns were associated with distinct prognostic profiles. Natural language processing of MRI reports revealed differing word distributions between recurrent and non-recurrent cases. The study supports the prognostic relevance of imaging and electrophysiologic markers and lays groundwork for machine-learning–based prediction tools to guide surgical decision-making.