Darren B. Orbach

Dr. Orbach is heavily engaged in both clinical neurointerventional and basic/translational imaging research. Clinically, the national and international reputation of the Cerebrovascular Surgery and Interventions Center, along with that of allied specialists in Neurosurgery, Neurointensive Care, Neurology, the Maternal Fetal Care Center, 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 deepening our understanding of cerebrovascular disease and its relation to vascular development more broadly. Dr. Orbach and colleagues have pioneered team-wide approaches for managing the most challenging and complex cerebrovascular conditions in children, with the highest reported levels of clinical efficacy and safety.

A particular focus of Dr. Orbach’s clinical research in the recent past has been the development of a first-in-humans fetal transuterine intervention for vein of Galen malformation (VOGM). Boston Children’s is a major referral center for VOGM, both prenatally and postnatally, but even with expert management, a significant fraction of newborns with this condition face high levels of mortality and major neurological morbidity. Working with a multidisciplinary group at Boston Children’s Hospital and Brigham & Women’s Hospital that had pioneered the development of in utero needle-guided interventions for major congenital cardiac anomalies, Dr. Orbach developed a novel approach for needle-guided access to the fetal brain to allow for embolization of the VOGM, with the goal of significantly reducing flow and improving outcomes in the newborns. The approach was tested in a fetal brain phantom developed by the Boston Children’s Simulations Program, and FDA and IRB approval were obtained for a formal clinical trial of this approach. Recruitment is actively underway.

On the basic research front, Dr. Orbach heads a neurovascular imaging research group, consisting of colleagues with expertise in MRI physics, neuroradiology, neurosurgery, and neurology. The focus of the group is on developing new MRI-based techniques for assessing and quantitating the characteristics of blood flow to the brain in children and fetuses, including flow velocity in particular vessels, brain tissue perfusion, and other characteristics. Much of the basic cerebrovascular physiology in the developing fetus and in very young children has not been previously elucidated, and it is hoped that this research will illuminate both the expected developmental pathway as well as how the system goes awry in illness.

Finally, in addition to cerebrovascular research, Dr. Orbach has had a long-standing interest in brain function, mediated by electrical discharges. For the past several years, he has worked in collaboration with the synthetic neurobiology group at the McGovern Institute at MIT to develop “vascular neural interfaces” (VNI) – tiny implants deployed by catheters within the cerebral arterial tree that are capable of wirelessly recording and stimulating electrical activity from adjacent brain regions. While there are numerous potential clinical uses for such devices, current research is focused on the use of VNI as tools for basic neuroscience inquiry, with the goal of measuring electrical discharges from deep locations in the brain without invasive electrodes penetrating the brain tissue itself.