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Studies have widely analyzed topography as a determinant of epileptogenesis. However, the association between lesion volumetry and epileptic risk remains poorly investigated, as no objective volumetric thresholds have been established to stratify seizure risk. We conducted a multicentric case\u2013control study including 230 adult patients with CCMs. Patients were grouped according to their initial presentation: seizure (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200975) versus non-seizure (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009155). We calculated the volumes of the lesions using the ABC\/2 method and categorized them into quartiles. Subsequently, we run a multivariate logistic regression assessing independent predictors of epilepsy, adjusting for demographic, clinical, and radiological factors. We also estimated the diagnostic accuracy of lesion volume thresholds (&gt;\u200911.9 mm\n                    <jats:sup>3<\/jats:sup>\n                    ,\u2009&gt;\u200980 mm\n                    <jats:sup>3<\/jats:sup>\n                    ,\u2009&gt;\u2009300 mm\n                    <jats:sup>3<\/jats:sup>\n                    ). Lesion volume was significantly associated with epileptic risk. Lesions\u2009\u2265\u200980 mm\n                    <jats:sup>3<\/jats:sup>\n                    were shown to have higher odds of seizures on presentation (OR 86.4, 95% CI 9.94\u2013751). We found hemorrhagic presentation (OR 60.3, 95% CI 6.50\u2013558) and frontal or temporal location (OR 6.34, 95% CI 2.99\u2013113.4) to be also independent predictors of seizure. Differently, demographic and pharmacologic factors were not independently predictive. Lesion volume, hemorrhage, andfrontal or temporal lobe location were found to be the major predictors of epileptic seizure as first manifestation. Therefore, incorporating volumetric assessment into routine MRI evaluation, after establishing absolute thresholds, may improve individualized risk stratification and guide early management decisions.\n                  <\/jats:p>","DOI":"10.1007\/s10143-026-04246-5","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:34:49Z","timestamp":1774658089000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of seizure as presenting symptom of cerebral cavernomas"],"prefix":"10.1007","volume":"49","author":[{"given":"Carmelo Lucio","family":"Sturiale","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Palermo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Elena","family":"Flacco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Mantovani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Albanese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"De Bonis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Scerrati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"issue":"3","key":"4246_CR1","doi-asserted-by":"publisher","first-page":"onsE135","DOI":"10.1227\/01.NEU.0000335654.56346.B6","volume":"64","author":"A Albanese","year":"2009","unstructured":"Albanese A, Sturiale CL, D\u2019Alessandris QG, Capone G, Maira G (2009) Calcified extra-axial cavernoma involving lower cranial nerves: technical case report. 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The correct author names appeared in this erratum article. The original article online has been corrected.","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2026","order":9,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":10,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":11,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1007\/s10143-026-04301-1","URL":"https:\/\/doi.org\/10.1007\/s10143-026-04301-1","order":12,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was reviewed and approved by the Local Ethical Committee (approval ID 670\/2021\/Oss\/AOUFe). All participating institutions adhered to standardized procedures for data collection, patient confidentiality, and ethical conduct in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial number"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"318"}}