Asgeir Store Jakola

• M.D., Ph.D.
• Professor at Sahlgrenska University Hospital

Context There are no controlled studies on surgical treatment of diffuse low-grade gliomas (LGGs), and management is controversial. Objective To examine survival in population-based parallel cohorts of LGGs from 2 Norwegian university hospitals with different surgical treatment strategies. Design, Setting, and Patients Both neurosurgical department...

Objective To test the equivalence for clinical effectiveness between microdecompression and laminectomy in patients with central lumbar spinal stenosis. Design Multicentre observational study. Setting Prospective data from the Norwegian Registry for Spine Surgery. Participants 885 patients with central stenosis of the lumbar spine who underwent...

This study tests the hypothesis that quantitative profiling of cell type composition and tissue architecture in isocitrate dehydrogenase (IDH)-mutant gliomas can provide valuable insights into tumor aggressiveness, treatment response, and survival. Towards this goal, we have established a novel method to analyze cell composition and tissue architec...

Purpose Adult patients with diffuse lower-grade gliomas (dLGG) show heterogeneous survival outcomes, complicating postoperative treatment planning. Treating all patients early increases the risk of long-term side effects, while delayed treatment may lead to impaired survival. Refinement of prognostic models could optimize timing of treatment. Conve...

Background Brain metastases (BM) are a major clinical challenge in metastatic lung adenocarcinoma (LUAD), affecting up to 50% of patients during disease progression. Current guidelines do not mandate brain imaging for all metastatic lung cancer patients at diagnosis unless there are neurological symptoms present. However, real-world data on the pre...

Purpose Glioblastoma (GBM) is an aggressive brain tumor often accompanied by a vasogenic peritumoral edema, which contributes to symptoms both at diagnosis and during later stages of the disease. Previous studies have suggested effectiveness of the endogenous protein, Antisecretory Factor (AF), in reducing the intracranial pressure in cytotoxic bra...

Purpose Patients with diffuse lower-grade gliomas (LGG) often suffer from mental fatigue. In healthy subjects, mental fatigue has a negative impact on cognitive functioning. This relation may be more complex in LGG, where tumor localization and growth rate also impact brain function. Our aim was to investigate how self- and observer-reported variab...

OBJECTIVE The extent of resection (EOR) and postoperative residual tumor (RT) volume are prognostic factors in glioblastoma. Calculations of EOR and RT rely on accurate tumor segmentations. Raidionics is an open-access software that enables automatic segmentation of preoperative and early postoperative glioblastoma using pretrained deep learning mo...

Isocitrate dehydrogenase (IDH)-mutant gliomas, comprising both astrocytomas and oligodendrogliomas, represent a distinct group of tumors that pose an interdisciplinary challenge. Addressing the needs of affected patients requires close collaboration among various disciplines, including neuropathology, neuroradiology, neurosurgery, radiation oncolog...

Purpose Extent of resection, MGMT promoter methylation status, age, functional level, and residual tumor volume are established prognostic factors for overall survival in glioblastoma patients. Preoperative tumor volume has also been investigated, but the results have been inconclusive. We hypothesized that the surface area and the shape were more...

PURPOSE IDH-mutant astrocytomas CNS WHO grade 2 and 3 show heterogenous appearance on magnetic resonance imaging (MRI). In the pre-molecular era, the discrepancy between T1 hypointense and T2 hyperintense tumor volume in absolute values has been proposed as a marker for diffuse tumor growth. We set out to investigate if a ratio of T1 to T2 tumor vo...

Diagnostic delays impact the quality of life and survival of patients with brain cancer. Currently, with no blood test to assist them, clinicians must make their referral decision based on symptoms. Existing symptom-based referral guidelines inadequately stratify patients for brain imaging based on suspicion of cancer. A simple, rapid liquid biopsy...

Background Malignant brain tumors often lead to death. While improving future treatments is essential, end-of-life care must also be addressed. To ensure equitable palliative care, understanding place of death is crucial, as disparities may lead to inequity of care. This study aims to identify place of death in adults with malignant brain tumors in...

BACKGROUND Radiologically presumed diffuse lower-grade glioma (dLGG) are typically non or minimal enhancing tumors, with hyperintensity in T2w-images. The aim of this study was to test the clinical usefulness of deep learning (DL) in IDH mutation prediction in patients with radiologically presumed dLGG. METHODS 314 patients were retrospectively re...

Background and purpose: Progression-free survival (PFS) remains to be validated as an outcome measure for diffuse WHO grade 2 gliomas, and knowledge about the relationships between PFS, post-progression survival (PPS), and overall survival (OS) in this subset of tumors is limited. We sought to assess correlations between PFS and OS, and identify fa...

BACKGROUND Diffuse lower-grade gliomas (dLGG) are nowadays characterized by the IDH mutation. Presumed dLGG are typically non or minimal enhancing tumors, with hyperintensity in T2w-images. However, one third of the radiologically presumed dLGG turn out to be patients with IDH wild-type and have a disadvantaged prognosis. The aim of this study was...

BACKGROUND The treatment in malignant brain tumour is multimodal and consists of a combination of surgery, radiotherapy, and chemotherapy. The average survival differs depending on e.g. degree of malignancy and location. Potential palliative needs also need attention. This preliminary study seeks to utilize registry data to identify the place of de...

BACKGROUND IDH-mutated gliomas are primary brain tumours that typically affect relatively young individuals. As survival rates have increased due to changes in treatment strategies, maintaining health-related quality of life (HRQoL) has become more significant. This study will investigate factors influencing HRQoL in patients with IDH-mutated gliom...

BACKGROUND Although proton radiotherapy has been used in a large scale for quite some time, published data from trials confirming the safety of proton therapy are still scarce. Yet, there are indications of radiation induced contrast enhancement (RICE) being more common after proton radiotherapy than photon radiotherapy. MATERIAL AND METHODS Betwe...

Glioma resection is associated with prolonged survival, but neuro-oncological trials have frequently refrained from quantifying the extent of resection. The Response Assessment in Neuro-Oncology (RANO) resect group is an international, multidisciplinary group that aims to standardise research practice by delineating the oncological role of surgery...

Background Schwannomas and meningiomas are intradural extramedullary spinal tumors which are regularly encountered in the neurosurgical clinic. These tumors cause neurological deficit by compression on the spinal cord and commonly pain when affecting the cauda equina. The traditional treatment with standard laminectomy (SL) can cause instability to...

Tertiary lymphoid structures (TLS) are ectopic lymphoid aggregates associated with improved prognosis in numerous tumors. To date, their prognostic value in central nervous system cancers and the events underlying their formation remain unclear. Here, we find that TLS correlate with improved survival in glioblastoma patients. Furthermore, combining...

BACKGROUND AND OBJECTIVES Isocitrate dehydrogenase (IDH)–mutant astrocytomas central nervous system World Health Organization grade 2 and 3 show heterogeneous appearance on MRI. In the premolecular era, the discrepancy between T1 hypointense and T2 hyperintense tumor volume in absolute values has been proposed as a marker for diffuse tumor growth....

Background Asymptomatic patients with meningiomas are increasingly detected, where management can be challenging in terms of surgery versus watchful waiting. Health-related quality of life (HRQoL) is an important factor in clinical decision making, albeit not greatly studied in this patient group. The aim of this paper is to map the HRQoL among pat...

Introduction Technical advances and the increasing role of interdisciplinary decision-making may warrant formal definitions of expertise in surgical neuro-oncology. Research question The EANS Neuro-oncology Section felt that a survey detailing the European neurosurgical perspective on the concept of expertise in surgical neuro-oncology might be he...

Background At group level, health-related quality of life (HRQoL) in patients with IDH-mutant diffuse glioma grade 2 and 3 seems to remain stable over time. However, clinical experience indicates that there are patients with unfavorable outcomes on key HRQoL subdomains. The aim of this longitudinal population-based study, following patients over a...

Background Postoperative drainage systems have become a standard treatment for chronic subdural hematoma (CSDH). We previously compared treatment results from three Scandinavian centers using three different postoperative drainage systems and concluded that the active subgaleal drainage was associated with lower recurrence and complication rates th...

The discovery of the glymphatic system has revolutionized our understanding of cerebrospinal fluid (CSF) circulation and interstitial waste clearance in the brain. This scoping review aims to synthesize the current literature on the glymphatic system’s role in neurosurgical conditions and its potential as a therapeutic target. We conducted a compre...

The 2021 World Health Organization (WHO) grading system of isocitrate dehydrogenase (IDH)‐mutant astrocytomas relies on histological features and the presence of homozygous deletion of the cyclin‐dependent kinase inhibitor 2A and 2B (CDKN2A/B). DNA methylation profiling has become highly relevant in the diagnosis of central nervous system (CNS) tum...

Background Knowledge about meningioma growth characteristics is needed for developing biologically rational follow-up routines. In this study of untreated meningiomas followed with repeated MRIs, we studied growth dynamics and explored potential factors associated with tumor growth. Methods In a single-center cohort study, we included 235 adult pa...

The aim of this study was to study the use of brain scanning, and the subsequent findings of presumed incidental meningioma in two time periods, and to study differences in follow-up, treatment, and outcome. Records of all performed CT and MRI of the brain during two time periods were retrospectively reviewed in search of patients with presumed inc...

Extent of resection after surgery is one of the main prognostic factors for patients diagnosed with glioblastoma. To achieve this, accurate segmentation and classification of residual tumor from post-operative MR images is essential. The current standard method for estimating it is subject to high inter- and intra-rater variability, and an automate...

Purpose The aim of this study was to study the use of brain scanning, and the subsequent findings of presumed incidental meningioma in two time periods, and to study differences in follow-up, treatment, and outcome. Methods Records of performed CT and MRI of the brain were retrospectively reviewed in search for patients with presumed incidental me...

BACKGROUND Mesenchymal transformation in glioblastomas is associated with therapy resistance and increased aggressiveness. In WHO 2021-defined adult-type diffuse gliomas of lower grade (dLGG), the transition between phenotypic states, has not been studied. Most reports correlating proneural, classical or mesenchymal signatures with outcome in dLGG...

BACKGROUND Meningiomas constitute a large portion of brain tumors, with an often indolent natural course of disease. There a now more asymptomatic meningiomas diagnosed each year as compared to their symptomatic counterparts. With brain imaging widely available, increased findings of incidental meningiomas have emerged. There are many unique challe...

BACKGROUND Low-grade gliomas are by the latest WHO classification exclusively IDH-mutated tumors, and are further divided into astrocytomas (1p19q non co-deleted) and oligodendrogliomas (1p19q co-deleted). Radiomics, that is extraction of mathematical features of images, has prognostic potential and the method is able to capture properties of whole...

BACKGROUND Diffuse low-grade gliomas are slow-growing malignant brain tumors that mainly affect people in their 30s and 40s, usually resulting in death within a decade. The standard treatment is surgery, which has a moderate risk of neurological sequelae. Clinical experience indicates that not all sequels are directly related to the resected area b...

BACKGROUND In the 2021 WHO classification system, the glioma subgroup IDH-mutated astrocytomas grade 4 was introduced, and diagnosis can be based upon molecular or histopathological morphological criteria. We here explore if the reason for a diagnosis of WHO grade 4 IDH mutated astrocytoma influences survival. MATERIAL AND METHODS Twenty-five pati...

Background Glioblastoma is the most common and most aggressive primary brain tumor in adults. Despite multimodal treatment, the median survival time is 15–16 months and 5-year survival rate 5%–10%. The primary goal of this study was to identify prognostic factors for survival in an unselected population of patients operated for glioblastoma. The se...

Purpose Since the introduction of the molecular definition of oligodendrogliomas based on isocitrate dehydrogenase (IDH)-status and the 1p19q-codeletion, it has become increasingly evident how this glioma entity differs much from other diffuse lower grade gliomas and stands out with longer survival and often better responsiveness to adjuvant therap...

This follow-up study examines back pain–related disability at 6 months following a randomized trial of spinal cord burst stimulation for chronic radicular pain after lumbar spine surgery.

Background Deep learning (DL) has shown promising results in molecular-based classification of glioma subtypes from MR images. DL requires a large number of training data for achieving good generalization performance. Since brain tumor datasets are usually small in size, combination of such datasets from different hospitals are needed. Data privacy...

Objectives Accumulating evidence shows that mesenchymal transition of glioblastomas is associated with a more aggressive course of disease and therapy resistance. In WHO2021-defined adult-type diffuse gliomas of lower grade (dLGG), the transition of the tumor phenotype over time, has not been studied. Most efforts to correlate proneural, classical...

Extent of resection after surgery is one of the main prognostic factors for patients diagnosed with glioblastoma. To achieve this, accurate segmentation and classification of residual tumor from post-operative MR images is essential. The current standard method for estimating it is subject to high inter-and intra-rater variability, and an automated...

Background: Clinical methods to quantify brain injury related to neurosurgery are scarce. Circulating brain injury biomarkers have recently gained increased interest as new ultrasensitive measurement techniques have enabled quantification of brain injury through blood sampling. Objective: To establish the time profile of the increase in the circ...

Glioblastomas are aggressive brain tumors that are largely immunotherapy resistant. This is associated with immunosuppression and a dysfunctional tumor vasculature, which hinder T cell infiltration. LIGHT/TNFSF14 can induce high endothelial venules (HEVs) and tertiary lymphoid structures (TLS), suggesting that its therapeutic expression could promo...

Extent of resection after surgery is one of the main prognostic factors for patients diagnosed with glioblastoma. To achieve this, accurate segmentation and classification of residual tumor from post-operative MR images is essential. The current standard method for estimating it is subject to high inter- and intra-rater variability, and an automate...

Background Roughly 50% of adult gliomas harbor isocitrate dehydrogenase (IDH) mutations. According to the 2021 WHO classification guideline, these gliomas are diagnosed as astrocytomas, harboring no 1p19q co-deletion, or oligodendrogliomas, harboring 1p19q co-deletion. Recent studies report that IDH-mutant gliomas share a common developmental hiera...

Glioblastoma multiforme (GBM) is the most common and aggressive brain tumor in adults and is highly resistant to chemo- and radiotherapies. GBM has been associated with alterations in lipid contents, but lipid metabolism reprogramming in tumor cells is not fully elucidated. One of the key hurdles is to localize the lipid species that are correlated...

Objective and methods: We conducted a retrospective review of the first 30 patients treated with stereotactic laser ablation (SLA) at our institution since the introduction of the technique in September 2019. We aimed to analyze our initial results and potential learning curve by investigating precision and lesion coverage and assessing the freque...

Introduction: : Meningioma has a prevalence around 1% in the population and with the increasing use and availability of diagnostic imaging modalities incidental meningiomas are increasingly detected. There is no clear consensus on their management, although several guidelines suggest firsthand active monitoring if no aggravating factors emerge. Ho...

Introduction The use of proton therapy increases globally despite a lack of randomised controlled trials demonstrating its efficacy and safety. Proton therapy enables sparing of non-neoplastic tissue from radiation. This is principally beneficial and holds promise of reduced long-term side effects. However, the sparing of seemingly non-cancerous ti...

Importance: Disulfiram has demonstrated broad antitumoral effect in several preclinical studies. One of the proposed indications is for the treatment of glioblastoma. Objective: To evaluate the efficacy and safety of disulfiram and copper as add-on to alkylating chemotherapy in patients with recurrent glioblastoma. Design, setting, and particip...

The glymphatic system as a concept was introduced a decade ago and the knowledge regarding the circulation of the cerebrospinal fluid has since been revised. The research of the glymphatic system is extensive today, but there are many knowledge gaps. The glymphatic system was first investigated in animal experiments, but with the MR techniques avai...

Diffuse gliomas are the most prevalent malignant primary brain tumors in adults and remain incurable despite standard therapy. Tumor recurrence is currently inevitable, which contributes to a persistent high morbidity and mortality in these patients. In this study, we examined the genome-wide DNA methylation profiles of primary and recurrent adult-...

Treatment of adult patients with brain tumors is a multi-disciplinary effort involving several medical disciplines: neurosurgery, oncology, neurology, neuropathology, neuroradiology, and rehabilitation medicine. While the brain tumor field has gone through vast diagnostical changes during the last decade, the hopes of similar achievements in the sy...

Purpose: In patients with diffuse low-grade glioma (LGG), the extent of surgical tumor resection (EOR) has a controversial role, in part because a randomized clinical trial with different levels of EOR is not feasible. Methods: In a 20-year retrospective cohort of 392 patients with IDH-mutant grade 2 glioma, we analyzed the combined effects of v...

Introduction Meningiomas account for nearly 40% of intracranial tumors. Recently, the immunohistochemistry (IHC) markers S100B, SCGN, ACADL and MCM2 have been shown to be associated with underlying biological subtypes of meningioma (MG1-MG4). We aimed to evaluate these IHC markers in a clinical setting. Research question Are the new proposed IHC m...

Background Isocitrate dehydrogenase ( IDH ) mutated diffuse lower-grade gliomas (dLGG) are infiltrating brain tumors and increasing evidence is in favor of early multimodal treatment. In a Scandinavian population-based setting, we wanted to study treatment patterns over the last 15 years, focusing on the short-term postoperative course to better un...

Importance The effect of a physical property of irrigation fluid (at body vs room temperature) on recurrence rate in the evacuation of chronic subdural hematoma (cSDH) needs further study. Objective To explore whether irrigation fluid temperature has an influence on cSDH recurrence. Design, Setting, and Participants This was a multicenter randomi...

Purpose Most patients with Lower Grade Gliomas (LGG) present with epileptic seizures. Since the advent of molecular diagnostics, more homogenous sub-entities have emerged, including the isocitrate dehydrogenase-mutated (IDH-mutated) astrocytomas and 1p19q-codeleted oligodendrogliomas. We aimed to describe the occurrence of seizures in patients with...

Importance: The use of spinal cord stimulation for chronic pain after lumbar spine surgery is increasing, yet rigorous evidence of its efficacy is lacking. Objective: To investigate the efficacy of spinal cord burst stimulation, which involves the placement of an implantable pulse generator connected to electrodes with leads that travel into the...

Purpose Risk of cancer has been associated with body or organ size in several studies. We sought to investigate the relationship between intracranial volume (ICV) (as a proxy for lifetime maximum brain size) and risk of IDH -mutant low-grade glioma. Methods In a multicenter case–control study based on population-based data, we included 154 patient...

Ketogenic diets (KD) have received increasing interest in neuro-oncology based on their ability to inhibit glioma growth In Vitro and their established role in medically refractory seizures. This review analyses the methodological aspects of KD treatment alongside standard care for patients with gliomas from a nutritional point of view. A literatur...

Objective To report our experience and investigate frequencies of adverse events and functional status from the first 5 years of performing awake surgery for gliomas in a single-center population-based setting. Methods We conducted a review of all patients with a glioma treated with awake surgery during the first 5 years following introduction of...

In the new WHO 2021 Classification of CNS Tumors the chapter “Circumscribed astrocytic gliomas, glioneuronal and neuronal tumors” encompasses several different rare tumor entities, which occur more frequently in children, adolescents and young adults. The Task Force has reviewed the evidence of diagnostic and therapeutic interventions, which is low...

For patients suffering from brain tumor, prognosis estimation and treatment decisions are made by a multidisciplinary team based on a set of preoperative MR scans. Currently, the lack of standardized and automatic methods for tumor detection and generation of clinical reports, incorporating a wide range of tumor characteristics, represents a major...

In most deep learning-based brain tumor segmentation methods, training the deep network requires annotated tumor areas. However, accurate tumor annotation puts high demands on medical personnel. The aim of this study is to train a deep network for segmentation by using ellipse box areas surrounding the tumors. In the proposed method, the deep netwo...

Objectives To determine the reproducibility and replicability of studies that develop and validate segmentation methods for brain tumours on MRI and that follow established reproducibility criteria; and to evaluate whether the reporting guidelines are sufficient. Methods Two eligible validation studies of distinct deep learning (DL) methods were i...

Background The subventricular zone (SVZ) of the human brain is a site of adult stem cell proliferation and a microenvironment for neural stem cells (NSCs). It has been suggested that NSCs in the SVZ are potential cells of origin containing driver mutations of glioblastoma, but their role in the origin of diffuse lower-grade gliomas (dLGG) is not mu...

The purpose of this study was to explore how persons having received various treatments for glioma, a type of brain tumour, experience their language, speech, and communication in everyday life. Twelve persons with low-grade glioma and one with high-grade glioma who had undergone tumour resection in 2014-2016 in different tumour locations were inte...

Adult-type diffuse gliomas and meningiomas are the most common primary intracranial tumors of the central nervous system. DNA methylation profiling is a novel diagnostic technique increasingly used also in the clinic. Although molecular heterogeneity is well described in these tumors, DNA methylation heterogeneity is less studied. We therefore inve...

Background For brain tumors, identifying the molecular subtypes from magnetic resonance imaging (MRI) is desirable, but remains a challenging task. Recent machine learning and deep learning (DL) approaches may help the classification/prediction of tumor subtypes through MRIs. However, most of these methods require annotated data with ground truth (...

For patients suffering from brain tumor, prognosis estimation and treatment decisions are made by a multidisciplinary team based on a set of preoperative MR scans. Currently, the lack of standardized and automatic methods for tumor detection and generation of clinical reports represents a major hurdle. In this study, we investigate glioblastomas, l...

Meningioma is the most common benign intracranial tumor and is believed to arise from arachnoid cap cells of arachnoid granulations. We sought to develop a population-based atlas from pre-treatment MRIs to explore the distribution of intracranial meningiomas and to explore risk factors for development of intracranial meningiomas in different locati...

OBJECTIVE IDH -mutant diffuse low-grade gliomas (dLGGs; WHO grade 2) are often considered to have a more indolent course. In particular, in patients with 1p19q codeleted oligodendrogliomas, survival can be very long. Therefore, extended follow-up in clinical studies of IDH- mutant dLGG is needed. The authors’ primary aim was to determine results af...

Background There is currently limited evidence for surgery in recurrent glioblastoma (GBM). Our aim was to compare primary and recurrent surgeries, regarding changes in perioperative, generic health-related quality of life (HRQoL), complications, extents of resection and survival. Methods Between 2007 and 2018, 65 recurrent and 160 primary GBM res...

Due to the lack of reliable prognostic tools, prognostication and surgical decisions largely rely on the neurosurgeons’ clinical prediction skills. The aim of this study was to assess the accuracy of neurosurgeons’ prediction of survival in patients with high-grade glioma and explore factors possibly associated with accurate predictions. In a prosp...

Background While molecular insights to diffuse lower-grade glioma (dLGG) have improved the basis for prognostication, most established clinical prognostic factors come from the pre-molecular era. For instance, WHO grade as a predictor for survival in dLGG with isocitrate dehydrogenase (IDH) mutation has recently been questioned. We studied the prog...

The use of deep learning (DL) is rapidly increasing in clinical neuroscience. The term denotes models with multiple sequential layers of learning algorithms, architecturally similar to neural networks of the brain. We provide examples of DL in analyzing MRI data and discuss potential applications and methodological caveats.Important aspects are dat...