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However, <jats:italic>SURGERY<\/jats:italic> poses a significantly higher risk of facial-function deterioration (FFD). The aim of this study was to illustrate the effectiveness in terms of number-needed-to-treat\/operate (NNO), number-needed-to-harm (NNH), and likelihood-of-harm\/help (LHH) by comparing both treatment modalities in large VS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This was a retrospective, dual-center cohort study. Tumor size was classified by Hannover Classification. Absolute risk reduction and risk increase were used to derive additional estimates of treatment effectiveness, namely NNO and NNH. LHH was then calculated by a quotient of NNH\/NNO to illustrate the risk\u2013benefit-ratio of <jats:italic>SURGERY<\/jats:italic>.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Four hundred and forty\u2013nine patients treated met the inclusion criteria. The incidence of tumor recurrence was significantly higher in <jats:italic>SRS<\/jats:italic> (14%), compared to <jats:italic>SURGERY<\/jats:italic> (3%) resulting in ARR of 11% and NNO of 10. At the same time, <jats:italic>SURGERY<\/jats:italic> was related to a significant risk of FFD resulting in an NNH of 12. Overall, the LHH calculated at 1.20 was favored <jats:italic>SURGERY,<\/jats:italic> especially in patients under the age of 40\u00a0years (LHH\u2009=\u20092.40), cystic VS (LHH\u2009=\u20094.33), and Hannover T3a (LHH\u2009=\u20091.83) and T3b (LHH\u2009=\u20091.80).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Due to a poorer response of large VS to <jats:italic>SRS<\/jats:italic>, <jats:italic>SURGERY<\/jats:italic> is superior with respect to tumor control. One tumor recurrence can be prevented, when 10 patients are treated by <jats:italic>SURGERY<\/jats:italic> instead of <jats:italic>SRS<\/jats:italic>. Thus, LHH portrays the benefit of <jats:italic>SURGERY<\/jats:italic> in large VS even when taking raised FFD into account.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11060-024-04732-0","type":"journal-article","created":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T02:02:02Z","timestamp":1719885722000},"page":"299-308","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Likelihood-of-harm\/help of microsurgery compared to radiosurgery in large vestibular schwannoma"],"prefix":"10.1007","volume":"169","author":[{"given":"Sophie Shih-Y\u00fcng","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard","family":"Horstmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albertus","family":"van Eck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"Tatagiba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Naros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,29]]},"reference":[{"issue":"1","key":"4732_CR1","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1093\/neuonc\/noz153","volume":"22","author":"R Goldbrunner","year":"2020","unstructured":"Goldbrunner R, Weller M, Regis J et al (2020) EANO guideline on the diagnosis and treatment of vestibular schwannoma. 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