Brain mapping in neuro-oncology: what is the future?

Surgery is the first treatment in neuro-oncology. However, brain gliomas are frequently located within eloquent areas. Therefore, in order to maximize the extent of resection while preserving cerebral functions, owing to major interindividual anatomo-functional variability across patients, functional mapping is now mandatory. Preoperative functional neuroimaging allows a better understanding of the individual organization of brain networks, leading to optimized surgical indications and planning. Intrasurgical cortical and subcortical stimulation, often carried out in awake patients, enables assessment of the performance of online anatomo-functional correlations, with increased resection according to functional boundaries. Postoperative functional neuroimaging following recovery, regularly carried out after active rehabilitation, provides information regarding cerebral plasticity over time, possibly opening the door to another surgery(ies). In summary, brain mapping allows surgical removal in eloquent areas classically considered as 'inoperable', and also preservation or even improvement of quality of life, while increasing median survival. The future persepctive is now to move towards dynamic therapeutic strategy based on a multiple-stage surgical approach, combined with (neo) adjuvant chemotherapy and/or radiotherapy. In addition, cerebral mapping enables a better knowledge of brain processing, especially concerning connectivity and plasticity, creating a link between neuro-oncology and cognitive neurosciences, and opening the concept of ` functional neuro-oncology'.