Hippocampal atrophy and developmental positional variants may co-occur in various neurological disorders. We propose a surface-based framework to analyze independently volume and positioning. After extracting the spherical harmonics combined with point distribution models (SPHARM-PDM) from manual labels, we computed displacement vectors between individual surfaces and the template. Then, we computed surface-based Jacobian determinants (SJD) from these vectors to localize volume changes. To analyze positional variants, we constructed a mean meridian axis (MEMAX), inheriting the shape-constrained point correspondences of SPHARM, on which we compute local curvatures and position vectors. We validated our method on synthetic shapes, and a large database of healthy subjects and patients with temporal lobe epilepsy. Our comprehensive analysis showed that in patients atrophy and positional changes co-occurred at the level of the posterior hippocampus. Indeed, in this region, while SPHARM-PDM showed mirrored deformations, SJD detected atrophy, and shape analysis of MEMAX unveiled medial positioning due to bending.