MENUMENU
- Craniosynostosis
-
-
- What is Craniosynostosis
- Syndromic Craniosynostosis
-
-
- More
-
- Who we are
- Photos & Videos
UF Health Neuromedicine Hospital
1505 SW Archer Road, 1st Floor
Gainesville, FL 32608
Phone:352-273-6990 / 352-273-9000
Lance S. Governale, MD, FAANS, FAAP is the Chief of Pediatric Neurosurgery and the L.D. Hupp Associate Professor of Neurosurgery and Pediatrics. He joined the University of Florida’s Department of Neurological Surgery in 2017 after serving as a Pediatric Neurosurgeon at Nationwide Children’s Hospital in Columbus, Ohio and an Assistant Professor of Neurosurgery at the Ohio State University College of Medicine.
Dr. Governale obtained his Bachelor of Science in Physiology and Neurobiology from the University of Maryland, research training from the National Institutes of Health, and his Medical Degree from Harvard Medical School. He then stayed at Harvard to complete neurosurgical residency training at Brigham and Women’s Hospital and pediatric neurosurgical fellowship training at Children’s Hospital Boston.
Dr. Governale has the distinction of having received awards from his colleagues for excellence in research, teaching, and clinical care, including the Harvard Medical School Richardson Research Fellowship for MD Scientists and a nomination for the Harvard Medical School Faculty Prize for Excellence in Teaching. His research interests focus on clinical outcomes, quality improvement, and medical informatics; and he is a member of multiple professional societies including the American Association of Neurological Surgeons, the American Society of Pediatric Neurosurgeons, and the American Academy of Pediatrics.
Although he enjoys the full range of pediatric neurosurgery, Dr. Governale is especially interested in craniosynostosis, minimally invasive neurosurgery (including endoscopic treatment of hydrocephalus, craniosynostosis, pituitary disease, and skull base disease), brain / spinal cord tumors, tethered spinal cords, arachnoid cysts, and cavernous malformations. He is board certified by both the American Board of Neurological Surgery and the American Board of Pediatric Neurological Surgery.
“
“
The goals of craniosynostosis surgery are to unlock and reshape the bones. Historically, craniosynostosis has been treated using surgical methods that involve an incision from ear to ear and the removal, reshaping and reattachment of affected bones. However, at UF Health Shands Children’s Hospital, advances in technology are allowing us to conduct more of these procedures in a minimally invasive manner.
With traditional surgery, the procedure lasts approximately four hours and is performed in conjunction with a craniofacial plastic surgeon. A blood transfusion is often necessary. The child is typically observed overnight in the ICU and then an additional three days on the regular neurosurgical floor before discharge. Pronounced periorbital edema is normal, but generally resolves before discharge. To reduce surgical risk, this procedure is performed around the age of 6 months. Younger infants are very unlikely to experience increased intracranial pressure before then. Syndromic and multiple suture cases are more frequently treated using traditional surgical techniques. Because reshaping occurs at the time of surgery, no further interventions are required.
Minimally invasive surgery involves two small incisions and the removal of only the fused suture to unlock the bones. The surgery lasts approximately one hour and rarely requires a blood transfusion. Postoperatively, the child is observed overnight on the regular neurosurgical floor and is then discharged. Usually, there is no periorbital swelling. Minimally invasive surgery produces the most successful outcomes when performed on children before the age of 6 months. With minimally invasive techniques, reshaping occurs postoperatively with the assistance of either a cranial molding helmet or implanted custom springs.
The cranial molding helmet has a hard outer shell with moldable foam on the inside. It is worn 23 hours per day until the child’s first birthday. The helmet does not press the skull into shape but rather directs the growth of the skull into a more normal shape. Because the helmet relies on the high rate of skull growth in the first year of life, helmet-assisted surgery should be done between 10 to 14 weeks of age. The helmet requires frequent visits to an orthotist but no additional surgery.
Stainless steel cranial expander springs are implanted after the fused suture is resected. The springs are then removed three months later. The level of spring tension is selected based on the patient’s age, bone thickness and deformity severity. Spring-assisted surgery is performed between the ages of 3 to 6 months. The springs require a second surgery for removal but not the use of the helmet.
“
