Jessica Ching, MD

Marissa and Jon Yeatman gave birth to a healthy baby boy named Nathaniel on Feb. 9, 2018, in Tallahassee, Florida. He was their second child and made their daughter a big sister, a position she was eager to take on.

Three days after his birth, Marissa and Jon took their baby to the pediatrician for his newborn checkup, and the doctor noticed an abnormality in the shape of Nathaniel’s skull.

“The pediatrician took pretty much one look at him and said, ‘Let’s take some X-rays,’” Marissa said.

Though Nathaniel’s head only had a mildly pinched appearance, his abnormal head shape foreshadowed a much more serious problem. Nathaniel was diagnosed with sagittal craniosynostosis, a birth defect in which one of the fibrous joints between the bones of Nathaniel’s skull closed prematurely before his brain was fully formed.

“Usually when you look at a newborn’s head on an X-ray, it looks like the skull is kind of shattered, but part of his looked like it was already formed and closed like an adult,” Marissa said.

Their pediatrician recommended Lance S. Governale, M.D., UF Health’s chief of pediatric neurosurgery who has a focus in craniosynostosis. The Yeatmans contacted him immediately, hoping to resolve the issue as quickly as possible.

Dr. Governale knew he needed to treat the problem early, so he scheduled the Yeatmans for an appointment close to their home at the UF Health Pediatric Specialties practice in Tallahassee.

“At that point, he was like new, new to the world,” Marissa said. “He was only about a month old. So, our options were kind of broadened, because we caught it so young.”

To gather more information, Dr. Governale obtained a special CT scan. CT scans involve some amount of radiation exposure, but at UF Health’s Gainesville and Tallahassee locations, Dr. Governale introduced ultra- low-dose CT scanning. These scans provide 3D views of the skull at a radiation dose similar to a few X-rays and much lower than standard CT scans.
After Nathaniel’s CT scan confirmed the condition, Dr. Governale laid out three different treatment options.

“The skull is made up of multiple different bones with sutures in between them,” Governale said. “Sutures allow the skull to grow. If they close early, it alters the head shape. In addition, suture closure can restrict skull growth while the brain is trying to grow leading to increased pressure.”

Craniosynostosis is typically treated surgically, due to the need to unlock the bones and reshape the skull. The traditional surgery, larger and more invasive, would probably require a blood transfusion and a longer hospital stay, but Dr. Governale was committed to offering minimally invasive options.

“One minimally invasive option consists of unlocking the bones through one or two small incisions with the assistance of an endoscope, and then using a helmet afterward to reshape the skull,” Governale said. “The downside is that the helmet has to be worn for 23 hours per day for upwards of nine months. It also requires regular visits to a helmet orthotist, who may not be located in the family’s region, like Tallahassee.”

Because of these issues, Dr. Governale and his pediatric craniofacial plastic surgery partner, Jessica A. Ching, M.D., introduced a second minimally invasive option to UF Health — cranial expander springs. With springs, a helmet is not required. UF Health Shands Children’s Hospital in Gainesville is the only site in Florida offering this newest treatment option.

Though she trusted the physician’s expertise, Marissa was relieved to feel as if she wasn’t forced into one specific treatment option for her baby boy. She felt that Dr. Governale let her have the final say.

“He was really good about not pushing one option over the others,” Marissa said. “He said if there was one option that was better than the other two, he wouldn’t offer the other two.”

That third, minimally invasive option for Nathaniel was the one that the nervous parents eventually chose.

In May of 2018, Nathaniel underwent craniosynostosis surgery with cranial expander spring implantation. Drs. Governale and Ching made one incision, used an endoscope to help open the sealed suture and then put in two cranial expander springs to reshape the skull. Three and a half months later, they went back in and took out the springs, completing the process — no helmet required.

A team approach is essential for treating craniosynostosis. The physicians work side-by-side to tailor the treatment to the patient and involve other specialists if needed, including ENT, oral surgery, dentistry, genetics, speech therapy, audiology, psychology and social work. Although Nathaniel did not need those additional specialists, he did have one more added benefit of Dr. Ching’s participation in the surgery — a beautiful closure with minimal scarring, something Marissa and Sean are very thankful for.

“She did an amazing job with all of his stitches and everything,” Marissa said. “The scar was actually, originally, a pretty odd U-shape. As his head is growing, it has started to stretch and look straighter. Already, you can’t see the incision that much.”