The goal of this review is to briefly present the main recent advances of research in malignant gliomas and to consider future developments, in a clinical perspective. The main challenges appear to be the following: (1) To better understand the etiology of gliomas and to differentiate the respective roles of environmental and genetic factors. (2) To improve the diagnostic and follow up tools, not only through refined neuroimaging techniques but also by discovering serum biomarkers. (3) To build a reliable molecular classification of gliomas that may be used for diagnostic and therapeutic purposes. (4) To develop a "molecular-based" clinical research. Neuro-Oncology has now reached a new therapeutic era and many methodological and medico-economic questions need to be solved.