Byron and Molly Wise

heaped on the fun, touring their 14-year-old, Michael Etuckmelra, around the

,

,

, Multnomah Falls, Mt. St. Helens and

. They tried to fit in everything Michael wanted to do before April 29, when Byron posted a worry-worthy message on Facebook:

"Tomorrow is Michael's surgery. Please keep him in your prayers."

A large tumor was crushing the eighth-grader's pituitary gland, at the base of his brain, and if it didn't come out, it would kill or severely disable him. Rather than opening his skull and lifting his brain to reach it -- long the standard practice but one fraught with danger -- surgeons at

planned to extract the tumor without making a single incision in Michael's skin. They'd pull it out through his nose.

The procedure with a long-winded name -- extended endonasal endoscope-assisted skull base craniotomy -- illustrates the speedy evolution that fiber-optic technology has brought to neurosurgery. Few such operations are believed to have been performed on children anywhere, and two were at Doernbecher during the past few months. Michael's would be No. 3.

Doctors told the Wises that though the surgery was the best approach for their funny, straight-talking, sports-loving boy, there were no guarantees.

***

One of seven children

in the Wise's blended family, Michael first complained of headaches last October. The pain, he remembers, felt like "someone was grabbing my brain and making it smaller."

But given the time he puts in studying, often staying after school for hours to get ahead, his mother and stepfather figured eye strain caused the throbbing in their son's head.

They were more concerned about his height, 4-feet-8. Though he's broad-shouldered and stocky, other kids his age tower over him.

Every few months doctors swing through their village of

, about 370 air miles southwest of Anchorage on the Alaska Peninsula, home to about 70 people. They'd told the Wises not to worry, predicting that at puberty Michael would have a growth spurt.

But the physician who stopped in Pilot Point in January noticed Michael's growth had slowed far too much since he was about 12. She referred him to a pediatrician in Dillingham, Alaska, who sent him to an endocrinologist in Anchorage.

Byron was with him there on April 2 when the doctor delivered shocking news: Michael had a craniopharyngioma, a rare, calcified, 2-centimeter-by-1-centimeter tumor squashing his pituitary gland.

The pea-sized gland secretes hormones controlling growth, among other functions, and the tumor was the reason Michael hadn't grown normally.

Craniopharyngiomas grow slowly and are unlikely to spread, but they can severely damage structures in the brain -- or worse. His was adjacent to the carotid and basilar arteries, which supply blood to the brain and brain stem, optic nerves, hypothalamus and elsewhere.

As Alaskan doctors frequently do when children require oncology care or neurosurgery, they told the Wises Michael's best bet was nearly 1,700 miles away at Doernbecher in Portland.

***

Pilot Point's residents live close to the land

, hunting moose, smoking fish and gathering berries to sustain them through frigid winters. Come spring, the population swells with fishermen drawn by bountiful salmon runs.

Byron is their village's public safety officer, handling everything from law enforcement to emergency medical care and search-and-rescue. Molly held a similar post but is a stay-home mom now.

A dozen kids attend Michael's school, but together they're a mighty force. In the last couple years, students set their sights on the most awesome field trip they could fathom: to Hawaii.

Michael and the others held cakewalks, bake sales and raffles. The village has no restaurants, so the kids catered restaurant nights, designing menus, cooking, serving and busing tables.

Plus, they scripted, shot, edited and uploaded

, explaining who they are, how they live, what they hoped to study in Hawaii and their effort to raise money. One clip shows Michael's fingertip, a jet drawn on it, sliding down a globe from the 49th state to the 50th.

Astoundingly, they raised about $35,000, and set a May 19 departure date. Their traveling crew would be one member shy.

***

Doctors at many medical centers

attempt to excise tumors like Michael's with craniotomies, opening the skull and lifting the brain to reach the growth. But the process is arduous and surgeons have a tough time removing the entire growth, given its location deep in the middle of the head, behind the eyes. Risks include permanent vision loss or irreversible brain damage.

On April 30, Michael's doctors angled to reach his tumor, instead, from underneath. Surgeons only recently refined the technique to make it an option for children, whose nasal passages are far narrower than those of adults.

Michael's doctors worked as a tag team.

,

director of head and neck oncology, fished an endoscope -- a tiny, fiber optic camera -- up one of Michael's nostrils and surgical instruments up the other. He punched a quarter-size hole through wafer-thin bone at the skull base so

, Doernbecher's head of pediatric neurosurgery, could reach the dura, the tough sack that holds the brain, blood vessels and cerebrospinal fluid.

Watching the endoscope's view on a video monitor, Selden could see the tumor squishing down Michael's pituitary gland and pushing up his optic chiasm, the part of the brain where the optic nerves cross. He carved out the tumor and extracted it through Michael's nostril, the sharp camera view enabling him to avoid disturbing the brain's most delicate structures.

Andersen moved in again. He sealed the surgical opening with a flap of nasal tissue, aiming to keep cerebrospinal fluid from leaking into the teen's nose.

Leaking fluid, the surgery's one drawback and its most common complication, is bad business. It can lead to meningitis, a life-threatening bacterial infection of the membranes covering the brain and spinal cord. With luck, the patch deep inside Michael's head would hold.

On Facebook, Byron wrote: "The doctor said it went better than he could have hoped ... Your prayers were heard in Portland, Oregon, today!"

***

Doctors kept a close eye on Michael

in the pediatric intensive-care unit. Byron and Molly did, too.

For the most part, their kids have been healthy, save the occasional broken wrist or ingrown toenail. But Molly lost a 4 1/2-year-old developmentally disabled daughter years ago.

At Doernbecher, where rooms brim with children struggling to regain their health, the pair seldom left Michael's side.

"I always thought of myself as being strong," Byron wrote on Facebook on May 4, "but not as strong as what these kids and Michael have shown. I am grateful that this place exists. ..."

***

The hospital discharged Michael

eight days after surgery but advised him and his folks to stay close. They settled into a Southwest Portland motel, instructed to watch for drainage into Michael's nose.

Two nights later, he lost his appetite, his nose ran, a fever set in and his respiration grew rapid. Michael and his folks headed for the emergency department.

Tumor excisions similar to his were tried decades ago but the method, Selden says, was abandoned. Entering from the brain's underside, it was too difficult for surgeons to see what they were doing. Plus, too often, spinal fluid leaked afterward.

Development of endoscopes solved the visualization problem, though, and otolaryngologists -- ear, nose and throat specialists -- improved patching techniques to stop leaks; the dura opening is so small, surgeons can't simply stitch it closed.

Neither of the two Doernbecher patients who earlier this year had the same surgery as Michael suffered cerebrospinal fluid leaks.

By afternoon, he was back in surgery. With Selden helping, Andersen went in through Michael's nostrils again, fashioned another patch and packed the area with absorbent material. Surgeons also installed a drain in the boy's spine to temporarily divert extra fluid.

Doctors expected that within days scar tissue would form, eventually growing into a permanent patch. Two days later, it leaked. Michael returned to surgery.

Doctors and nurses kept him sedated in intensive-care for days afterward, hoping that the less he moved, the more quickly the wound might heal. But 12 days later, the morning Michael expected to be discharged, doctors found leak the size of a pin hole.

"It's frustrating," Selden says, "but this is like a case study of the one drawback of this operation ... It can be a multi-step healing process."

So the Friday before Memorial Day weekend, as Oregonians fired up barbecues or headed for the beach, the medical team rolled Michael back into surgery.

***

Sitting cross-legged in his hospital bed

five days later, Michael looked and sounded better than he had in a month. Beneath his pitch-black bangs, the swelling in his eye from the original surgery had subsided. He had so much energy he asked for schoolwork -- math, his favorite subject. And he giggled listening to a phone recording of his 6-year-old sister, Alayssa, singing "You Are My Sunshine" to her big brother from back home in Alaska.

He missed her and the rest of his family, friends, neighbors and his rat terrier, Viper. Like his folks, who'd spent a month trying to sleep in window seats or recliners in Michael's hospital rooms, he yearned for his own bed.

Michael will have to be vigilant about his health. Because the tumor damaged his pituitary gland, he'll need medication for life. Doctors expect to start him on growth hormone next year.

Given all they've been through, he and his folks aren't sweating that. They have better things to think about -- much better. This weekend, they expect to head home.

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