Neuro-oncology has evolved as a growing, but still small, highly specialised and multidisciplinary field at the interface of several diagnostic and therapeutic disciplines. The major challenge in the field of primary tumours is to translate the almost unique progress in deciphering the highly complex molecular genetic nature of many primary brain tumours, notably glioblastoma, into advances that allow for clinical benefit for affected patients. Furthermore, metastases to the central nervous system are an increasingly prevalent complication in many systemic cancers. Their diagnosis and management require major expertise, notably with consideration of several new systemic therapy options, such as targeted therapy and immuno-oncology approaches. These new treatments contribute to challenges within the third major domain of neuro-oncology, the diagnosis, treatment and prevention of nervous system toxicity of old and new anti-cancer treatments. All these considerations strongly argue for the development of specialised centres of excellence to improve care for patients with brain tumour across Europe.