The insufficient remnant liver volume (RLV) is the main reason for postoperative hepatic failure and death of patients. The lesions of hepatic alveolar echinococcosis (HAE) often involve the intra- and extra-hepatic vessels, which causes difficult situations for preservation of the functional hepatic segment (s) and low radical resection rates. Although the ex-vivo liver resection combined with autologous liver transplantation (ERAT) has greatly extended the surgical indications for end-stage HAE, the insufficient RLV remains the restrictions on HAE radical resection. In recent years, some novel techniques such as the staged hepatectomy, percutaneous stenting of hepatic vein followed by ERAT, and auxiliary ERAT as well as the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) have been applied in the surgical treatment for HAE patients with insufficient RLV, which improve the radical resection rate for end-stage HAE. Herein, the authors present a brief overview on the latest surgical progress for end-stage HAE with insufficient RLV.