Dr. Orbach is heavily engaged in both clinical neurointerventional and basic/translational imaging research. On the clinical front, the international reputation of the groups at Children's with expertise related to complex vascular malformations of the brain, spine, and head & neck - Neuroradiology, Neurosurgery, Neurology, Otolaryngology, and the Vascular Anomalies Center - results in worldwide referrals and a high volume of patients with pediatric cerebrovascular conditions rarely seen elsewhere. Clinical research flows naturally, with rich opportunities for (i) deepening our understanding of cerebrovascular disease and its relation to vascular development and anomalies more broadly, as well as for (ii) pioneering, in children, the adoption and modification of neurointerventional techniques originally developed for use in adults. As Division Chief of Interventional Radiology (IR), Dr. Orbach is overseeing the development of a novel pediatric IR Oncology effort, working with medical and surgical oncology colleagues at Boston Children’s Hospital (BCH) and Dana Farber to use the tools of image-guided therapy to offer children with solid tumors new options for both primary and palliative treatment.
Dr. Orbach’s basic research efforts have focused on the development of novel magnetic resonance imaging techniques for directly visualizing electrical discharges in the brain. Current functional imaging techniques rely on metabolic and blood flow changes for visualizing active regions of the brain, but these second-order physiological changes are relatively far-removed from neuronal activity itself. Using a novel technique they developed, combining high-speed MR acquisition and simultaneous EEG (encephalographic MRI), Dr. Orbach and his colleagues are attempting to directly visualize foci of abnormal interictal discharges in patients with epilepsy. Human imaging is supplemented with: (i) in vitro high-field MR imaging of isolated turtle cerebellum, which allows for direct electrical stimulation without the confounders of blood flow and respiratory movements, and (ii) MR imaging of custom-built electrical current phantoms designed to mimic particular aspects of the intracranial environment, in order to help elucidate the mechanisms underlying the fast imaging signal changes seen in the epilepsy cohort. The work is intrinsically a multidisciplinary group effort involving MR physicists, experts in signal and image processing, and epilepsy neurologists.
About Darren B. Orbach, MD, PhD
Dr. Darren Orbach graduated from Princeton University and then went on to an MD-PhD program at Cornell Medical School and Rockefeller University. He completed a combined clinical training program in neurology, radiology, and diagnostic & interventional neuroradiology at NYU Medical Center. Moving to Boston in 2006, he joined the departments of Radiology and Neurosurgery at Brigham and Women’s Hospital as a neurointerventionalist, covering pediatric cases at Children's as well. In 2009, he became full-time Director of Neurointerventional Radiology at BCH, and in 2010, Division Chief of Interventional Radiology.
- Orbach D, Romanelli P, Devinsky O, Doyle W. Late seizure recurrence after multiple subpial transections. Epilepsia 2001;42:1130-3.
- Orbach D, Ritaccio A, Devinsky O. Psychogenic, non epileptic seizures associated with video-EEG verified sleep. Epilepsia 2003;44:64-8.
- Orbach DB, Pramanik BK, Lee J, Maldonado T, Riles T, Grossman RI. Evaluation of the stented carotid artery with CT angiography and CT virtual angioscopy. Radiology 2006;238:309-20.
- Choi D, Alomari A, Chaudry G, Orbach DB. Neurointerventional management of low-flow vascular malformations of the head and neck. In: Interventional Neuroradiology of the Head and Neck, editor: Dheeraj Ghandi. Neuroimaging Clinics of N America 2009;19:199-218.
- Wu I, Orbach DB. Neurointerventional management of high-flow vascular malformations of the head and neck. In: Interventional Neuroradiology of the Head and Neck, editor: Dheeraj Ghandi. Neuroimaging Clinics of N America 2009;19:219-40.
- Viswanathan V, Smith ER, Mulliken JB, Fishman SJ, Kozakewich HPW, Burrows PE, Orbach DB. Infantile hemangiomas involving the neuraxis: Clinical and imaging findings. AJNR 2009;30:1005-13.
- Thiex R, Williams A, Smith ER, Scott RM, Orbach DB. The use of Onyx for embolization of central nervous system arteriovenous lesions in pediatric patients. AJNR 2010;31:112-20.
- Thiex R, Mulliken JB, Revencu N, Boon LM, Burrows PE, Cordisco M, Yim D, Smith ER, Vikkula M, Orbach DB. A novel association between RASA1 mutations and spinal arteriovenous anomalies. AJNR 2010;31:775-9.
- Sundaram P, Wells WM, Mulkern RV, Bubrick EJ, Bromfield EB, Munch M, Orbach DB. Fast human brain magnetic resonance responses associated with epileptiform spikes. Magn Res Med 2010;64:1728-38.
- Alomari AI, Chaudry G, Rodesch G, Burrows PE, Mulliken JB, Smith ER, Orbach DB. Complex spinal-paraspinal high-flow lesions in CLOVES Syndrome: Analysis of clinical and imaging findings. AJNR 2011;32:1812-7.
- Sundaram P, Mulkern RV, Wells WM, Triantafyllou C, Loddenkemper T, Bubrick EJ, Orbach DB. An empirical investigation of motion effects in eMRI of interictal epileptiform spikes. MRI 2011;29:1401-9.
- Morris SA, Orbach DB, Geva T, Singh MN, Gauvreau K, Lacro R. Increased vertebral artery tortuosity index is associated with adverse outcomes in children and young adults with connective tissue disorders. Circulation 2011;124:388-96.
- Greene A, Orbach DB. Management of arteriovenous malformations. In: Vascular Anomalies, editors: Arin Greene, Chad Perlyn. Clinics in Plastic Surgery 2011;38:95-106.
- Ellis MJ, Armstrong D, Vachhrajani S, Kulkarni AV, Dirks PB, Drake JM, Smith ER, Scott RM, Orbach DB. Angioarchitectural features associated with hemorrhagic presentation in pediatric cerebral arteriovenous malformations. J Neurointerv Surg. 2012.
- Silvera VM, Gordon LB, Orbach DB, Campbell SE, Machan JT, Ullrich NJ. Imaging Characteristics of Cerebrovascular Arteriopathy and Stroke in Hutchinson-Gilford Progeria Syndrome. AJNR Am J Neuroradiol. 2012
- Ellis MJ, Amlie-Lefond C, Orbach DB. Endovascular therapy in children with acute ischemic stroke: review and recommendations. Neurology. 2012;79(13 Suppl 1):S158-164.
- Walcott BP, Smith ER, Scott RM, Orbach DB. Dural arteriovenous fistulae in pediatric patients: associated conditions and treatment outcomes. J Neurointerv Surg. 2013;5(1):6-9.
- Walcott BP, Smith ER, Scott RM, Orbach DB. Pial arteriovenous fistulae in pediatric patients: associated syndromes and treatment outcome. J Neurointerv Surg. 2013;5(1):10-14.
- Akgoz A, Gross B, Orbach DB. Pediatric ischemic infarct: A neurointerventional perspective. Pediatric Neuroradiology (in press).
- Gross B, Akgoz A, Orbach DB. Dural sinus malformations and fistulae in children. Pediatric Neuroradiology (in press).