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In this study, the authors investigated whether immediate postoperative diffusion tensor imaging (DTI) of the ION can serve as an early imaging marker of PFS.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors retrospectively reviewed pediatric brain tumor patients treated at their institution, Lucile Packard Children\u2019s Hospital at Stanford, from 2004 to 2016. They compared the immediate postoperative DTI studies obtained in 6 medulloblastoma patients who developed PFS to those of 6 age-matched controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Patients with PFS had statistically significant increased mean diffusivity (MD) in the left ION (1085.17 \u00b1 215.51 vs 860.17 \u00b1 102.64, p = 0.044) and variably increased MD in the right ION (923.17 \u00b1 119.2 vs 873.67 \u00b1 60.16, p = 0.385) compared with age-matched controls. Patients with PFS had downward trending fractional anisotropy (FA) in both the left (0.28 \u00b1 0.06 vs 0.23 \u00b1 0.03, p = 0.085) and right (0.29 \u00b1 0.06 vs 0.25 \u00b1 0.02, p = 0.164) IONs compared with age-matched controls, although neither of these values reached statistical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Increased MD in the ION is associated with development of PFS. 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