Spike ripples, combining epileptiform spikes and ripples, were evaluated as a reliable and improved biomarker for the epileptogenic zone (EZ) in a multicenter international study. An automated spike ripple detector was validated on intracranial EEG recordings and applied to 109 subjects who underwent surgical resection with known 1-year outcomes. Spike ripple rates were compared across subjects with seizure freedom (ILAE 1) and persistent seizures (ILAE 2–6). The proportion of resected events was calculated and compared across biomarkers. Overall, spike ripples were more frequently removed in ILAE 1 subjects compared to ILAE 2–6 subjects. Among ILAE 1 subjects, spike ripples were more likely to be removed than spikes, spike-gamma, wideband HFOs, ripples, or fast ripples. At the individual level, a higher proportion of ILAE 1 subjects had the majority of spike ripples removed compared to other biomarkers. Spike ripples localized the EZ better than other interictal biomarkers, suggesting they are a more specific marker for the EZ. The study found that spike ripples were more accurately removed in subjects with successful surgical outcomes, indicating their potential as a better biomarker for identifying the EZ. Spike ripples showed higher precision and lower false positive rates compared to other biomarkers. The results support the use of spike ripples as a more specific biomarker for the EZ than other interictal biomarkers. However, low spike ripple rates across all channels or high rates in non-resected hippocampal regions may reduce accuracy. The study concludes that spike ripples provide a better estimate of the EZ than other leading interictal biomarkers and are a valuable tool for guiding surgical resection.Spike ripples, combining epileptiform spikes and ripples, were evaluated as a reliable and improved biomarker for the epileptogenic zone (EZ) in a multicenter international study. An automated spike ripple detector was validated on intracranial EEG recordings and applied to 109 subjects who underwent surgical resection with known 1-year outcomes. Spike ripple rates were compared across subjects with seizure freedom (ILAE 1) and persistent seizures (ILAE 2–6). The proportion of resected events was calculated and compared across biomarkers. Overall, spike ripples were more frequently removed in ILAE 1 subjects compared to ILAE 2–6 subjects. Among ILAE 1 subjects, spike ripples were more likely to be removed than spikes, spike-gamma, wideband HFOs, ripples, or fast ripples. At the individual level, a higher proportion of ILAE 1 subjects had the majority of spike ripples removed compared to other biomarkers. Spike ripples localized the EZ better than other interictal biomarkers, suggesting they are a more specific marker for the EZ. The study found that spike ripples were more accurately removed in subjects with successful surgical outcomes, indicating their potential as a better biomarker for identifying the EZ. Spike ripples showed higher precision and lower false positive rates compared to other biomarkers. The results support the use of spike ripples as a more specific biomarker for the EZ than other interictal biomarkers. However, low spike ripple rates across all channels or high rates in non-resected hippocampal regions may reduce accuracy. The study concludes that spike ripples provide a better estimate of the EZ than other leading interictal biomarkers and are a valuable tool for guiding surgical resection.