Darren Orbach

Darren Orbach, MD, PhD

Division Chief, Interventional & Neurointerventional Radiology; Co-Director, Cerebrovascular Surgery and Interventions Center; Staff Neurointerventionalist

Associate Professor of Radiology, Harvard Medical School

Medical Services

Specialties

  • Neurointerventional Radiology
  • Neuroradiology
  • Neurovascular Imaging
  • Vascular Anomalies
  • Vein of Galen Malformations
  • Arteriovenous Malformation (AVM) of the Brain and Spine
  • Arteriovenous Fistulas (AVFs) of the Brain and Spine

Departments

  • Radiology

Programs

  • Cerebrovascular Surgery and Intervention Center
  • Stroke and Cerebrovascular Center
  • Neurointerventional Radiology
  • Vascular Anomalies Center
  • Interventional Radiology
  • Neuroradiology
To schedule an appointment: Call 617-919-1379 or Request an Appointment
Darren Orbach

I decided that I wanted to be a doctor when I was very young, early in elementary school. 

Also at an early age, I became very interested in the brain and how it works, how it is responsible for all those traits that make us human, and how it makes each of us into a unique individual.

I became so interested in those questions that as an undergraduate at Princeton University, I studied science and philosophy, with an emphasis on the philosophy of the mind and neuroscience. At one point, I thought I would be a pure researcher, and almost decided against medical school, but became convinced that some of the best research opportunities are found in medicine.

I pursued an MD/PhD at Cornell and Rockefeller University, allowing me both to treat patients and pursue neuroscience. At Cornell, I stumbled upon a new field, neurointerventional radiology, and was lucky enough to be accepted to a unique residency and fellowship program at New York University that provided cross-training in the various specialties that contribute to the field.

As a physician and scientist, I continue to be motivated by these two parallel drives. On the one hand, there is nothing like the gratification that comes with helping a child through a potentially devastating situation and seeing him or her thrive. When an infant patient, who faced a critical condition and underwent successful treatment, walks into my office years later as a healthy school-age child, there’s a jolt of joy and pride that makes everything else pale in comparison. Additionally, the conditions we treat are so rare and tools we use so new, that we are often working in uncharted territory and creating novel treatment strategies. Working through that as a care team with my colleagues and with the parents is absolutely exhilarating.

At the same time, my early passion for research is still very much there. I am committed to research into brain function and am working on developing new tools to enable us to visualize brain activity as it happens, at high resolution. My dream is to someday find an imaging tool that can help answer some of the most subtle and complex questions about the language of the brain: how it encodes information, how it generates and recalls feelings, and how it makes us who we are.

Experience and Education

Education

Undergraduate Degree

Princeton University, 1989

Princeton, NJ

Graduate Degree

The Rockefeller University, 1997

New York, NY

Medical Degree

Cornell University Medical College, 1998

New York, NY

Internship

NYU Medical Center, 1999

New York, NY

Residency, Diagnostic Radiology/Neurology

NYU Medical Center, 1999-2003

New York, NY

Fellowship, Diagnostic and Interventional Neuroradiology

NYU Medical Center, 2003-2005

New York, NY

Fellowship, Neurointerventional Radiology

NYU Medical Center, 2005-2006

New York, NY

Certifications

  • Diagnostic Radiology, Neuroradiology, Neurology

Professional History

I see patients in the relatively new subspecialty of pediatric neurointerventional radiology,  an area in which we at Boston Children's Hospital have built one of the world’s largest and most comprehensive practices. As the division chief of Interventional Radiology and the co-director of the hospital's Cerebrovascular Surgical and Interventions Center, my focus has been on children with neurovascular diseases and some cancers affecting the head and neck, using unique, guided approaches for treatment. I am passionate about making these novel treatment approaches, pioneered for use in adults, available to children.

I am dual-trained as both a physician and scientist, having obtained my medical degree from Cornell University Medical College and my doctorate from Rockefeller University, in the Laboratory of Biophysics and Neurophysiology. At New York University Medical Center, I completed residencies in neurology and diagnostic radiology and fellowships in diagnostic and interventional neuroradiology.

In my role as a leader of the hospital's Cerebrovascular Surgical and Interventions Center, I see children with conditions affecting blood vessels in and around the brain and the spine. I have worked closely with colleagues from Neurosurgery and Neurology to build an internationally recognized multidisciplinary group that tightly integrates all aspects of clinical care and outcomes research.

In children with intracranial and extracranial vascular anomalies, we have pioneered the use of devices developed for adults, often in creative ways different from their original designed purpose. We create precision 3D models of patients’ brains and blood vessels using data from their brain scans to help us plan procedures. We have demonstrated that it is possible to achieve high-quality image-guided treatment at low radiation doses. And new techniques are allowing us to safely access arteries even in the youngest patients.

In addition, I treat patients with head and neck solid tumors, primarily retinoblastoma, at Boston Children’s Hospital and the Dana Farber Institute. As division chief of Interventional Radiology, colleagues and I are exploring how we can further adapt techniques currently used in adults to help children with solid tumors, both for primary and secondary treatment, and for palliative treatment.

Research

I have both clinical and basic science research interests. Clinical research flows naturally from my practice in pediatric neurointerventional radiology and my work with the Cerebrovascular Surgery and Interventions Center and the Vascular Anomalies Center, where we see a high volume of patients with very rare vascular conditions.

My clinical research in this area aims to deepen our understanding of cerebrovascular disease and to bring neurointerventional techniques, originally developed for adults, to children, often necessitating creative re-purposing of devices and approaches. We have also focused heavily on providing our treatments with the lowest possible levels of radiation.

In terms of basic imaging research, my group has focused on developing new magnetic resonance imaging techniques to allow us to visualize electrical discharges in the brain. Current techniques use metabolic changes and blood flow changes to visualize parts of the brain that are active, but these changes are several steps removed from the actual electrical neuronal activity that is the language of the brain. I have worked with a multidisciplinary group of researchers to develop a novel technique combining high-speed MR acquisition and simultaneous EEG to directly visualize areas of the brain in which there are abnormal electrical discharges in patients with epilepsy.

The short-term hope is that a technique like this can both be useful for more accurately identifying electrically abnormal regions in epilepsy patients. Ultimately, our hope is that this may develop into a broad tool that will help us understand the organization of brain activity and encoding. Patients with epilepsy provide an excellent model because of the frequent occurrence of large-scale electrical discharges in the brains of children with this condition.

In addition to imaging patients, we have also supplemented human imaging with magnetic resonance images of electrical current phantoms that we designed to mimic various aspects of the discharges in the brain. Additionally, we used an isolated preparation of the cerebellum of the turtle to study the imaging response when electrical current is injected into living brain tissue, without confounders such as blood flow and respiration.

My publications reflect both my clinical and basic imaging research interests. Here is a selection:

Orbach D, Ritaccio A, Devinsky O. Psychogenic, nonepileptic seizures associated with video-EEG-verified sleep. Epilepsia. 2003 Jan;44(1):64-68. PMID: 12581231

Viswanathan V*, Smith ER, Mulliken JB, Fishman SJ, Kozakewich HP, Burrows PE, Orbach DB. Infantile hemangiomas involving the neuraxis: clinical and imaging findings. AJNR Am J Neuroradiol. 2009 May;30(5):1005-1013. PMID: 19213817

Thiex R* , Mulliken JB, Revencu N, Boon LM, Burrows PE, Cordisco M, Dwight Y, Smith ER, Vikkula M, Orbach DB. A novel association between RASA1 mutations and spinal arteriovenous anomalies. AJNR Am J Neuroradiol. 2010 Apr;31(4):775-779. PMID: 20007727

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 Reson Med. 2010 Dec;64(6):1728-1738. PMID: 20806355

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.
 

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.

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.

Orbach DB, Stamoulis C, Strauss KJ, Manchester J, Smith ER, Scott RM, Lin N. Neurointerventions in children: Radiation exposure and its import. AJNR Am J Neuroradiol. 2014 April. PMID: 24157736

Balasubramanian M*, Mulkern RV, Wells WM, Sundaram P, Orbach DB. Magnetic resonance imaging of ionic currents in solution: The effect of magnetohydrodynamic flow. Magn Reson Med. 2014 Oct 1. PMID: 25273917

Lin N*, Smith ER, Scott RM, Orbach DB. Safety of neuroangiography and embolization in children: complication analysis of 697 consecutive procedures in 394 patients. J Neurosurg Pediatr. 2015 Jun 26; 1-7. PMID: 26114994

Publications

Publications powered by Harvard Catalyst Profiles
  1. Satti S, Chen J, Sivapatham T, Jayaraman M, Orbach D. Mechanical thrombectomy for pediatric acute ischemic stroke: review of the literature. J Neurointerv Surg. 2016 Jul 22.
  2. See AP, Kochis MA, Khandelwal P, Orbach DB. Considerations in Applying a New Stent Retriever in Pediatric Endovascular Cerebral Thrombectomy for Acute Ischemic Stroke. Pediatr Neurosurg. 2016; 51(5):263-8.
  3. Sundaram P, Nummenmaa A, Wells W, Orbach D, Orringer D, Mulkern R, Okada Y. Direct neural current imaging in an intact cerebellum with magnetic resonance imaging. Neuroimage. 2016 May 15; 132:477-90.
  4. Ashour R, Orbach DB. Interventional neuroradiology in children: diagnostics and therapeutics. Curr Opin Pediatr. 2015 Dec; 27(6):700-5.
  5. Gross BA, Du R, Orbach DB, Scott RM, Smith ER. The natural history of cerebral cavernous malformations in children. J Neurosurg Pediatr. 2015 Oct 16; 1-6.
  6. Burch EA, Orbach DB. Pediatric central nervous system vascular malformations. Pediatr Radiol. 2015 Sep; 45 Suppl 3:S463-72.
  7. Weinstock P, Prabhu SP, Flynn K, Orbach DB, Smith E. Optimizing cerebrovascular surgical and endovascular procedures in children via personalized 3D printing. J Neurosurg Pediatr. 2015 Jul 31; 1-6.
  8. Lin N, Smith ER, Scott RM, Orbach DB. Safety of neuroangiography and embolization in children: complication analysis of 697 consecutive procedures in 394 patients. J Neurosurg Pediatr. 2015 Oct; 16(4):432-8.
  9. Ashour R, Orbach DB. Lower vertebral-epidural spinal arteriovenous fistulas: a unique subtype of vertebrovertebral arteriovenous fistula, treatable with coil and Penumbra Occlusion Device embolization. J Neurointerv Surg. 2016 Jun; 8(6):643-7.
  10. Gross BA, Smith ER, Scott RM, Orbach DB. Intracranial aneurysms in the youngest patients: characteristics and treatment challenges. Pediatr Neurosurg. 2015; 50(1):18-25.
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  12. Rodriguez-Galindo C, Orbach DB, VanderVeen D. Retinoblastoma. Pediatr Clin North Am. 2015 Feb; 62(1):201-23.
  13. Gross BA, Storey A, Orbach DB, Scott RM, Smith ER. Microsurgical treatment of arteriovenous malformations in pediatric patients: the Boston Children's Hospital experience. J Neurosurg Pediatr. 2015 Jan; 15(1):71-7.
  14. Balasubramanian M, Mulkern RV, Wells WM, Sundaram P, Orbach DB. Magnetic resonance imaging of ionic currents in solution: the effect of magnetohydrodynamic flow. Magn Reson Med. 2015 Oct; 74(4):1145-55.
  15. Monroy JE, Orbach DB, VanderVeen D. Complications of intra-arterial chemotherapy for retinoblastoma. Semin Ophthalmol. 2014 Sep-Nov; 29(5-6):429-33.
  16. Orbach DB, Vanderveen DK, Shah AS, Rodriguez-Galindo C. Blue toe syndrome: a complication of intra-arterial technique, not intra-arterial chemotherapy for retinoblastoma. JAMA Ophthalmol. 2014 May; 132(5):654.
  17. Chandra RV, Leslie-Mazwi TM, Orbach DB, Kaban LB, Rabinov JD. Transarterial embolization of mandibular arteriovenous malformations using ONYX. J Oral Maxillofac Surg. 2014 Aug; 72(8):1504-10.
  18. Orbach DB, Stamoulis C, Strauss KJ, Manchester J, Smith ER, Scott RM, Lin N. Neurointerventions in children: radiation exposure and its import. AJNR Am J Neuroradiol. 2014 Apr; 35(4):650-6.
  19. Yonekawa Y, Orbach DB, Trief D, Shah AS, Vanderveen DK. Intra-arterial chemotherapy for group C retinoblastoma with adjacent high-flow infantile hemangioma. Ophthalmic Surg Lasers Imaging Retina. 2013 Sep-Oct; 44(5):490-2.
  20. Orbach DB, Smith ER. Re: The influence of angioarchitecture on management of pediatric intracranial arteriovenous malformations. J Neurointerv Surg. 2016 Jun; 8(e1):e11-2.
  21. Gross BA, Orbach DB. Addressing challenges in 4 F and 5 F arterial access for neurointerventional procedures in infants and young children. J Neurointerv Surg. 2014 May; 6(4):308-13.
  22. Mulkern RV, Balasubramanian M, Orbach DB, Mitsouras D, Haker SJ. Incorporating reversible and irreversible transverse relaxation effects into Steady State Free Precession (SSFP) signal intensity expressions for fMRI considerations. Magn Reson Imaging. 2013 Apr; 31(3):346-52.
  23. 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. 2013 May; 34(5):1091-7.
  24. Ellis MJ, Amlie-Lefond C, Orbach DB. Endovascular therapy in children with acute ischemic stroke: review and recommendations. Neurology. 2012 Sep 25; 79(13 Suppl 1):S158-64.
  25. Macit B, Burrows PE, Yilmaz S, Orbach DB, Mulliken JB, Alomari AI. Cerebrofacial venous anomalies, sinus pericranii, ocular abnormalities and developmental delay. Interv Neuroradiol. 2012 Jun; 18(2):153-7.
  26. 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. 2013 May; 5(3):191-5.
  27. Walcott BP, Smith ER, Scott RM, Orbach DB. Pial arteriovenous fistulae in pediatric patients: associated syndromes and treatment outcome. J Neurointerv Surg. 2013 Jan 1; 5(1):10-4.
  28. Walcott BP, Smith ER, Scott RM, Orbach DB. Dural arteriovenous fistulae in pediatric patients: associated conditions and treatment outcomes. J Neurointerv Surg. 2013 Jan 1; 5(1):6-9.
  29. Kim SW, Kavanagh K, Kauvanough K, Orbach DB, Alomari AI, Mulliken JB, Rahbar R. Long-term outcome of radiofrequency ablation for intraoral microcystic lymphatic malformation. Arch Otolaryngol Head Neck Surg. 2011 Dec; 137(12):1247-50.
  30. Morris SA, Orbach DB, Geva T, Singh MN, Gauvreau K, Lacro RV. Increased vertebral artery tortuosity index is associated with adverse outcomes in children and young adults with connective tissue disorders. Circulation. 2011 Jul 26; 124(4):388-96.
  31. Puri AS, Rahbar R, Dearden J, Graham RJ, Lillehei C, Orbach DB. Stretched and sheared microcatheter retained after onyx embolization of infantile myofibromatosis. Interv Neuroradiol. 2011 Jun; 17(2):261-6.
  32. 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. Magn Reson Imaging. 2011 Dec; 29(10):1401-9.
  33. Puri AS, Thiex R, Zarzour H, Rahbar R, Orbach DB. Trigeminocardiac reflex in a child during pre-Onyx DMSO injection for juvenile nasopharyngeal angiofibroma embolization. A case report. Interv Neuroradiol. 2011 Mar; 17(1):13-6.
  34. Thiex R, Wu I, Mulliken JB, Greene AK, Rahbar R, Orbach DB. Safety and clinical efficacy of Onyx for embolization of extracranial head and neck vascular anomalies. AJNR Am J Neuroradiol. 2011 Jun-Jul; 32(6):1082-6.
  35. Alomari AI, Chaudry G, Rodesch G, Burrows PE, Mulliken JB, Smith ER, Fishman SJ, Orbach DB. Complex spinal-paraspinal fast-flow lesions in CLOVES syndrome: analysis of clinical and imaging findings in 6 patients. AJNR Am J Neuroradiol. 2011 Nov-Dec; 32(10):1812-7.
  36. Greene AK, Orbach DB. Management of arteriovenous malformations. Clin Plast Surg. 2011 Jan; 38(1):95-106.
  37. Sundaram P, Wells WM, Mulkern RV, Bubrick EJ, Bromfield EB, Münch M, Orbach DB. Fast human brain magnetic resonance responses associated with epileptiform spikes. Magn Reson Med. 2010 Dec; 64(6):1728-38.
  38. Alomari AI, Orbach DB, Mulliken JB, Bisdorff A, Fishman SJ, Norbash A, Alokaili R, Lord DJ, Burrows PE. Klippel-Trenaunay syndrome and spinal arteriovenous malformations: an erroneous association. AJNR Am J Neuroradiol. 2010 Oct; 31(9):1608-12.
  39. Thiex R, Mulliken JB, Revencu N, Boon LM, Burrows PE, Cordisco M, Dwight Y, Smith ER, Vikkula M, Orbach DB. A novel association between RASA1 mutations and spinal arteriovenous anomalies. AJNR Am J Neuroradiol. 2010 Apr; 31(4):775-9.
  40. Thiex R, Williams A, Smith E, Scott RM, Orbach DB. The use of Onyx for embolization of central nervous system arteriovenous lesions in pediatric patients. AJNR Am J Neuroradiol. 2010 Jan; 31(1):112-20.
  41. Wu IC, Orbach DB. Neurointerventional management of high-flow vascular malformations of the head and neck. Neuroimaging Clin N Am. 2009 May; 19(2):219-40, Table of Contents.
  42. Choi DJ, Alomari AI, Chaudry G, Orbach DB. Neurointerventional management of low-flow vascular malformations of the head and neck. Neuroimaging Clin N Am. 2009 May; 19(2):199-218.
  43. Viswanathan V, Smith ER, Mulliken JB, Fishman SJ, Kozakewich HP, Burrows PE, Orbach DB. Infantile hemangiomas involving the neuraxis: clinical and imaging findings. AJNR Am J Neuroradiol. 2009 May; 30(5):1005-13.
  44. Wang H, Oh AK, Orbach DB. Arteriovenous shunting as a new feature of PHACES. Case report. J Neurosurg Pediatr. 2009 Jan; 3(1):53-6.
  45. Wang H, Orbach DB. Traumatic dissecting aneurysm at the vertebrobasilar junction in a 3-month-old infant: evaluation and treatment strategies. Case report. J Neurosurg Pediatr. 2008 May; 1(5):415-9.
  46. Orbach DB, Mulliken JB. Re: Spinal epidural hemangiomas: various types of MR imaging features with histopathologic correlation. AJNR Am J Neuroradiol. 2008 May; 29(5):e31; author reply e32.
  47. Orbach DB, Wu C, Law M, Babb JS, Lee R, Padua A, Knopp EA. Comparing real-world advantages for the clinical neuroradiologist between a high field (3 T), a phased array (1.5 T) vs. a single-channel 1.5-T MR system. J Magn Reson Imaging. 2006 Jul; 24(1):16-24.
  48. Orbach DB, Pramanik BK, Lee J, Maldonado TS, Riles T, Grossman RI. Carotid artery stent implantation: evaluation with multi-detector row CT angiography and virtual angioscopy--initial experience. Radiology. 2006 Jan; 238(1):309-20.
  49. Lui YW, Nusbaum AO, Barr WB, Johnson G, Babb JS, Orbach D, Kim A, Laliotis G, Devinsky O. Correlation of apparent diffusion coefficient with neuropsychological testing in temporal lobe epilepsy. AJNR Am J Neuroradiol. 2005 Aug; 26(7):1832-9.
  50. Chatterjee A, Orbach D. Isolated foot weakness caused by a parasagittal metastatic parotid adenocarcinoma. Neurol India. 2004 Jun; 52(2):286-7.
  51. Devinsky O, Romanelli P, Orbach D, Pacia S, Doyle W. Surgical treatment of multifocal epilepsy involving eloquent cortex. Epilepsia. 2003 May; 44(5):718-23.
  52. Orbach D, Ritaccio A, Devinsky O. Psychogenic, nonepileptic seizures associated with video-EEG-verified sleep. Epilepsia. 2003 Jan; 44(1):64-8.
  53. Spencer SS, Schramm J, Wyler A, O'Connor M, Orbach D, Krauss G, Sperling M, Devinsky O, Elger C, Lesser R, Mulligan L, Westerveld M. Multiple subpial transection for intractable partial epilepsy: an international meta-analysis. Epilepsia. 2002 Feb; 43(2):141-5.
To schedule an appointment: Call 617-919-1379 or Request an Appointment

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