Both DMG and low-grade gliomas (LGG) occur within the brainstem and can be very difficult to distinguish. LGGs are very slow growing, well circumscribed or exophytic in character which provide treatment and surgical options not available for DMG. LGG’s are 95 % survivable at year five. To distinguish DMG from LGG prior to radiation treatments, it is important to consider the use of a biopsy, other new diagnostics as well as the assistance of the DIPG DMG National Brain Tumor Board for a second opinion. The tumor board, made up of pediatric neuro oncologists, with consulting neuro pathologists, neuro radiologists and neurosurgeons treat many DMG each year. The tumor board can assist in confirming the DMG diagnosis and can provide options for treatment, which will likely to be very different for LGG patients.