ABSTRACT
Until 25 years ago, there were many barriers to the timely diagnosis of brain and spinal tumors in children. Few family doctors or pediatricians had a good grasp of clinical neurology. The radiological modalities available were concentrated in specialist centers, and in general access to them was only through sometimes less than accessible colleagues in the form of neurosurgeons or neurologists, often at institutions some way from the child’s home. Before the advent of computed tomography (CT) scanning in the late 1970s, and magnetic resonance imaging (MRI) in the mid-1980s, investigation of a child suspected of harboring a brain or spinal tumor was a truly frightening experience for all concerned. Investigations were invasive, painful, and even dangerous. The most frequently used modalities of imaging were ventriculography, for suspected intracranial mass lesions, and myelography, for suspected intraspinal tumors. Textbooks often painted pictures of late stages in disease processes, emphasizing the importance of rather gross physical signs. Pediatricians were reluctant to refer children until clinical features were relatively far advanced, with the consequence that the neurosurgeon was faced all too often with the prospect of a child in poor condition and with advanced neurological disease.
