I’m Darren Orbach, and I’m a neurointerventionalist, which means I treat vascular disorders relating mostly to the central nervous system, so the brain and spinal cord. Also vascular conditions in the head and neck and the area around the spine, so the paraspinal area. Often those lesions* have a component that interacts with the brain or spine or they share a vascular supply or something that requires the intervention of someone who treats the actual brain and spine conditions even if the lesion* happens to be outside, so that’s sort of my focus.

How did you get interested in this pediatric population?
I was interested in this intellectually in training. I trained in New York at NYU which has a vascular anomalies group, but much smaller than we have here, and I was interested in this and I was interested in pediatric cerebrovascular disease. That’s part of what attracted me up to Boston, but there’s no question that being here in this environment with the referral base that we have and the group here has been fantastic in helping that grow. Most places don’t see anything like the volume that we do. It would be hard to build a practice out of the blue just because you’re interested without having the kind of referral base that we do, so that’s been a big piece of it.

What are some of the rewards of working with this population?
For me, the single best thing is the positive outcome that most of the patients have. Very few of my colleagues practice in a pediatric environment. It’s very rare, because you have to have this kind of referral pattern that we have, and as I said before the prognosis for the kids, at least for the central nervous system vascular lesions*, is so much better than for adults that it’s intensely gratifying to treat a child who’s facing death or neurologic devastation, and then have them be cured and have a totally normal life and develop normally; that’s about as good as it gets as a physician.

For the kids where it’s not quite like that, for example for a lot of the facial lesions*, it’s been remarkable for me to see how well they can manage. When I started doing this, there were some kids who have such prominent facial lesions* that you walk into the room and you’re taken aback when you first meet them. But then as you get to know them and you spend time with them, it just becomes more and more remarkable how they make their way through life and they’re sort of heroic to me, in a way, and their families too, and even though we can’t cure them, we absolutely work as hard as we can to make sure that they have the quality of life that they can have and that they’re living as full a life as they can, and that is gratifying too, in a similar way. So both of those things I think, have been fantastic and a big part of what I enjoy about the job.