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We present an image of diffuse intrinsic pontine glioma (DIPG) showing its relationship to white matter structures based on reconstructed tractography (figure). An 8-year-old girl presented with diplopia, right abducens nerve palsy, and mild ataxia. Reconstruction showed at the level of the pontine decussation a right-sided disruption of the pontocerebellar fibers anterior to the descending corticospinal fibers involving the pontine nuclei region. Understanding the white matter tract anatomy of DIPG in relation to surrounding structures critical for function by this method may have the potential to assist in minimizing functional deficit risk during biopsy, but requires future validation.

Teaching NeuroImages: Diffuse intrinsic pontine glioma in white matter