This study evaluates whether spike ripples, the combination of epileptiform spikes and ripples, serve as a reliable and improved biomarker for identifying the epileptogenic zone (EZ) compared to other leading interictal biomarkers. The research involved a multicenter, international study with 109 subjects who underwent intracranial EEG recordings and surgical resection, followed by at least one year of follow-up. The study validated an automated spike ripple detector on intracranial EEG recordings and applied it to subjects from four centers. The spike ripple rate was assessed in subjects who were seizure-free after resection (International League Against Epilepsy Class 1 outcome) and those with persistent seizures (ILAE 2–6). The study also evaluated other interictal biomarkers: spikes, spike-gamma, wideband high-frequency oscillations (HFOs), ripples, and fast ripples. The results showed that the majority of spike ripples were removed in subjects with successful surgical outcomes, and this was consistent across different sites and electrode types. Additionally, a higher proportion of spike ripples were removed in subjects with successful surgery compared to those with persistent seizures. Among subjects with successful surgery, the mean spike ripple rate was higher in the resected volume than in non-removed tissue. The study concluded that spike ripples better localize the epileptogenic tissue compared to other leading interictal biomarkers, making them a valuable tool for guiding surgical resection.This study evaluates whether spike ripples, the combination of epileptiform spikes and ripples, serve as a reliable and improved biomarker for identifying the epileptogenic zone (EZ) compared to other leading interictal biomarkers. The research involved a multicenter, international study with 109 subjects who underwent intracranial EEG recordings and surgical resection, followed by at least one year of follow-up. The study validated an automated spike ripple detector on intracranial EEG recordings and applied it to subjects from four centers. The spike ripple rate was assessed in subjects who were seizure-free after resection (International League Against Epilepsy Class 1 outcome) and those with persistent seizures (ILAE 2–6). The study also evaluated other interictal biomarkers: spikes, spike-gamma, wideband high-frequency oscillations (HFOs), ripples, and fast ripples. The results showed that the majority of spike ripples were removed in subjects with successful surgical outcomes, and this was consistent across different sites and electrode types. Additionally, a higher proportion of spike ripples were removed in subjects with successful surgery compared to those with persistent seizures. Among subjects with successful surgery, the mean spike ripple rate was higher in the resected volume than in non-removed tissue. The study concluded that spike ripples better localize the epileptogenic tissue compared to other leading interictal biomarkers, making them a valuable tool for guiding surgical resection.