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Successful episodic recollection can vary in the precision of the information recalled. The hypothesis that recollection precision requires functional neuroanatomical contributions distinct from those required for recollection success remains controversial. Some findings in individuals with hippocampal lesions have indicated that precision is dependent on the hippocampus. However, other neuroimaging and lesion studies have implicated regions outside of the mesial temporal lobe (MTL) in precision, such as parietal cortex. To further elucidate distinctions of recollection precision versus success, we examined whether they were differentially sensitive to aging and to unilateral MTL lesions. Precision and success were measured using a novel task that required memory for item-location associations across different spatial contexts. We found impairments in recollection precision, but not success, in older adults (59–80 years) relative to younger adults (18–33 years). Recollection precision was also selectively impaired in individuals with unilateral MTL resections made to treat refractory epilepsy. Moreover, recollection precision was significantly worse when resections included the hippocampus compared to when only non-hippocampal MTL tissue was resected. These findings suggest that the MTL is critically involved in the high-resolution binding required to support spatial recollection precision, and thus provide evidence for functional neuroanatomical differences between recollection success and precision.Recollection precision but not recollection success was impaired in older adults.Precision was also selectively impaired by unilateral mesial temporal resections.Precision was more impaired when resections included the hippocampus.Findings suggest functional neuroanatomical distinction of success and precision.