Research Overview

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.

Key Publications

  • 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 DBA 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).

Researcher Services

Researcher Areas

  • Cerebral Electromagnetic Activity
  • Encephalographic Functional Magnetic Resonance Imaging (efMRI)

Research Departments

PUBLICATIONS

Publications powered by Harvard Catalyst Profiles

  1. Riordan CP, Orbach DB, Smith ER, Scott RM. Acute fatal hemorrhage from previously undiagnosed cerebral arteriovenous malformations in children: a single-center experience. J Neurosurg Pediatr. 2018 Jun 01; 1-7. View abstract
  2. Duran D, Karschnia P, Gaillard JR, Karimy JK, Youngblood MW, DiLuna ML, Matouk CC, Aagaard-Kienitz B, Smith ER, Orbach DB, Rodesch G, Berenstein A, Gunel M, Kahle KT. Human genetics and molecular mechanisms of vein of Galen malformation. J Neurosurg Pediatr. 2018 Apr; 21(4):367-374. View abstract
  3. Penn DL, Lanpher AB, Klein JM, Kozakewich HPW, Kahle KT, Smith ER, Orbach DB. Multimodal treatment approach in a patient with multiple intracranial myxomatous aneurysms. J Neurosurg Pediatr. 2018 Mar; 21(3):315-321. View abstract
  4. Yang E, Storey A, Olson HE, Soul J, Estroff JA, Trenor CC, Cooper BK, Smith ER, Orbach DB. Imaging features and prognostic factors in fetal and postnatal torcular dural sinus malformations, part I: review of experience at Boston Children's Hospital. J Neurointerv Surg. 2018 May; 10(5):467-470. View abstract
  5. Yang E, Storey A, Olson HE, Soul J, Estroff JA, Trenor CC, Cooper BK, Smith ER, Orbach DB. Imaging features and prognostic factors in fetal and postnatal torcular dural sinus malformations, part II: synthesis of the literature and patient management. J Neurointerv Surg. 2018 May; 10(5):471-475. View abstract
  6. See AP, Kochis MA, Orbach DB. Segmental upper mid-basilar artery sacrifice in a child using a Micro Vascular Plug device for treatment of a basilar arteriovenous fistula compressing the brainstem. J Neurointerv Surg. 2017 10; 9(10):e37. View abstract
  7. Wolter NE, Adil E, Irace AL, Werger A, Perez-Atayde AR, Weldon C, Orbach DB, Rodriguez-Galindo C, Rahbar R. Malignant glomus tumors of the head and neck in children and adults: Evaluation and management. Laryngoscope. 2017 12; 127(12):2873-2882. View abstract
  8. See AP, Kochis MA, Orbach DB. Segmental upper mid-basilar artery sacrifice in a child using a Micro Vascular Plug device for treatment of a basilar arteriovenous fistula compressing the brainstem. BMJ Case Rep. 2017 Mar 09; 2017. View abstract
  9. Balasubramanian M, Wells WM, Ives JR, Britz P, Mulkern RV, Orbach DB. RF Heating of Gold Cup and Conductive Plastic Electrodes during Simultaneous EEG and MRI. Neurodiagn J. 2017; 57(1):69-83. View abstract
  10. Garzon MC, Epstein LG, Heyer GL, Frommelt PC, Orbach DB, Baylis AL, Blei F, Burrows PE, Chamlin SL, Chun RH, Hess CP, Joachim S, Johnson K, Kim W, Liang MG, Maheshwari M, McCoy GN, Metry DW, Monrad PA, Pope E, Powell J, Shwayder TA, Siegel DH, Tollefson MM, Vadivelu S, Lew SM, Frieden IJ, Drolet BA. PHACE Syndrome: Consensus-Derived Diagnosis and Care Recommendations. J Pediatr. 2016 11; 178:24-33.e2. View abstract
  11. Satti S, Chen J, Sivapatham T, Jayaraman M, Orbach D. Mechanical thrombectomy for pediatric acute ischemic stroke: review of the literature. J Neurointerv Surg. 2017 Aug; 9(8):732-737. View abstract
  12. 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. View abstract
  13. 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 05 15; 132:477-490. View abstract
  14. Ashour R, Orbach DB. Interventional neuroradiology in children: diagnostics and therapeutics. Curr Opin Pediatr. 2015 Dec; 27(6):700-5. View abstract
  15. 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. View abstract
  16. Burch EA, Orbach DB. Pediatric central nervous system vascular malformations. Pediatr Radiol. 2015 Sep; 45 Suppl 3:S463-72. View abstract
  17. 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. View abstract
  18. 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. View abstract
  19. 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. View abstract
  20. 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. View abstract
  21. Rodriguez-Galindo C, Orbach DB, VanderVeen D. Retinoblastoma. Pediatr Clin North Am. 2015 Feb; 62(1):201-23. View abstract
  22. 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. View abstract
  23. 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. View abstract
  24. Monroy JE, Orbach DB, VanderVeen D. Complications of intra-arterial chemotherapy for retinoblastoma. Semin Ophthalmol. 2014 Sep-Nov; 29(5-6):429-33. View abstract
  25. 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. View abstract
  26. 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. View abstract
  27. 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. View abstract
  28. 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. View abstract
  29. 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. View abstract
  30. 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. View abstract
  31. 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. View abstract
  32. 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. View abstract
  33. 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. View abstract
  34. 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. View abstract
  35. 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. View abstract
  36. Walcott BP, Smith ER, Scott RM, Orbach DB. Pial arteriovenous fistulae in pediatric patients: associated syndromes and treatment outcome. J Neurointerv Surg. 2013 Jan 01; 5(1):10-4. View abstract
  37. Walcott BP, Smith ER, Scott RM, Orbach DB. Dural arteriovenous fistulae in pediatric patients: associated conditions and treatment outcomes. J Neurointerv Surg. 2013 Jan 01; 5(1):6-9. View abstract
  38. 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. View abstract
  39. 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. View abstract
  40. 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. View abstract
  41. 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. View abstract
  42. 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. View abstract
  43. 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. View abstract
  44. 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. View abstract
  45. Greene AK, Orbach DB. Management of arteriovenous malformations. Clin Plast Surg. 2011 Jan; 38(1):95-106. View abstract
  46. 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. View abstract
  47. 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. View abstract
  48. 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. View abstract
  49. 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. View abstract
  50. 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. View abstract
  51. 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. View abstract
  52. 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. View abstract
  53. 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. View abstract
  54. 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. View abstract
  55. 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. View abstract
  56. 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. View abstract
  57. 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. View abstract
  58. 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. View abstract
  59. Chatterjee A, Orbach D. Isolated foot weakness caused by a parasagittal metastatic parotid adenocarcinoma. Neurol India. 2004 Jun; 52(2):286-7. View abstract
  60. 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. View abstract
  61. Orbach D, Ritaccio A, Devinsky O. Psychogenic, nonepileptic seizures associated with video-EEG-verified sleep. Epilepsia. 2003 Jan; 44(1):64-8. View abstract
  62. 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. View abstract