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fMRI has proved to be a reliable, safe, reproducible method with which to presurgically define eloquent areas. This technique gives us the opportunity to know in advance the actual situation of a lesion so that the surgeonsmay plan their approach strategy. This technique also allows the establishment of a presurgical evaluation of risk and enables the patient to be fully aware at the moment of informed consent. Despite the increase in its clinical applications, fMRI is still underused in the clinical field and should be performed almost routinely before surgery.

The use of high magnetic field strength fMRI units has the potential for improving considerably the sensitivity and specificity of functional studies. As a result of the high-field studies, fundamental neural dynamics taking place at a very small dimensional scale in specific laminar, columnar and multicolumnar domains have become directly visible. The advantages in terms of spatial resolution, temporal resolution, BOLD signal changes and noise behaviour depend on the acquisition sequence and on the practical combination of the acquisition parameters with the local microscopic brain structure. Nevertheless, high-field units can be expected to improve significantly the quality of the fMRI results and the level of neurophysiological information it is possible to gather from the data. The concurrent use of tailored processing strategies can make even more convenient the use of high-field systems.