<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03823482</url>
  </required_header>
  <id_info>
    <org_study_id>51</org_study_id>
    <nct_id>NCT03823482</nct_id>
  </id_info>
  <brief_title>Lidocaine and Perioperative Cytokine Levels in Blood and Cerebrospinal Fluid in Cerebral Aneurysm Patients</brief_title>
  <official_title>Effect of Regional Anesthesia With Lidocaine on Perioperative Levels of Interleukin-1β, Interleukin-6 and Tumor Necrosis Factor-α in Blood and Cerebrospinal Fluid in Cerebral Aneurysm Patients</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Clinical Hospital Centre Zagreb</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Clinical Hospital Centre Zagreb</source>
  <oversight_info>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Cerebral aneurysm surgery has significant mortality and morbidity rate. Inflammation plays a&#xD;
      key role in the pathogenesis of intracranial aneurysms, their rupture, subarachnoid&#xD;
      haemorrhage and neurologic complications. Brain injury activates immune cells and triggers&#xD;
      cytokine release. Cytokine level in blood and cerebrospinal fluid is an indicator of&#xD;
      inflammatory response. Cytokines contribute to secondary brain injury and can worsen the&#xD;
      outcome of the treatment. Preventing secondary brain injury by modulating inflammatory&#xD;
      response represents a therapeutic target. Lidocaine is local anesthetic that can be used in&#xD;
      neurosurgery for regional anesthesia of the scalp and for topical anesthesia of the throat&#xD;
      prior to direct laryngoscopy and endotracheal intubation. Except analgetic, lidocaine has&#xD;
      systemic anti-inflammatory and neuroprotective effect. It acts through several mechanisms on&#xD;
      various types of immune cells producing immunosuppressing effect. Lidocaine can act on&#xD;
      activated microglia within central nervous system causing attenuation of immune response.&#xD;
&#xD;
      Primary aim of this prospective randomized trial is to determine influence of lidocaine&#xD;
      administration on inflammatory cytokine levels in serum and cerebrospinal fluid during and&#xD;
      following cerebral aneurysm surgery. Secondary aim is to determine possible correlation&#xD;
      between levels of cytokines and incidence of neurologic and infectious postoperative&#xD;
      complications. For that purpose, postoperative neurological clinical status will be recorded.&#xD;
      Signs of vasospasm and pathological postoperative brain CT scan findings will be recorded.&#xD;
      Incidence of meningitis, pneumonia and sepsis in postoperative period will also be analyzed.&#xD;
&#xD;
      Hypothesis of this trial is that lidocaine administration during cerebral aneurysm surgery&#xD;
      would significantly change levels of pro-inflammatory cytokines in cerebrospinal fluid and&#xD;
      serum. Lower concentrations of pro-inflammatory cytokines can possibly contribute to better&#xD;
      outcome and significantly lower incidence of postoperative complications.&#xD;
      Enzyme-immunochemical analysis will be used to measure levels of interleukin-1β,&#xD;
      interleukin-6 and tumor necrosis factor-α in cerebrospinal fluid and serum. Investigation&#xD;
      group will have, during cerebrovascular surgery under general anesthesia, regional anesthesia&#xD;
      of the scalp and topical anesthesia of the throat prior to laryngoscopy, all done with&#xD;
      lidocaine. Control group will have general anesthesia without lidocaine administration.&#xD;
    </textblock>
  </brief_summary>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Enrolling by invitation</last_known_status>
  <start_date type="Actual">March 1, 2019</start_date>
  <completion_date type="Anticipated">December 1, 2021</completion_date>
  <primary_completion_date type="Anticipated">March 1, 2021</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Other</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Change in concentrations of interleukin-1β</measure>
    <time_frame>Up to 24 hours after anesthesia induction.</time_frame>
    <description>Concentrations of IL-1β in pg/ml in cerebrospinal fluid and serum measured by enzyme-linked immunosorbent assay</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in concentrations of interleukin-6</measure>
    <time_frame>Up to 24 hours after anesthesia induction.</time_frame>
    <description>Concentrations of IL-6 in pg/ml in cerebrospinal fluid and serum measured by enzyme-linked immunosorbent assay</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in concentrations of tumor necrosis factor α</measure>
    <time_frame>Up to 24 hours after anesthesia induction.</time_frame>
    <description>Concentrations of TNF-α in pg/ml in cerebrospinal fluid and serum measured by enzyme-linked immunosorbent assay</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Incidence of new motoric deficit</measure>
    <time_frame>Up to one week postoperatively</time_frame>
    <description>Clinical assessment of neurologic status incidence of generalized epileptic seizure, incidence of vasospasm, pathological finding on brain computerized tomography ( ischemia, edema, bleeding, hydrocephalus).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Incidence of generalized epileptic seizure</measure>
    <time_frame>Up to one week postoperatively</time_frame>
    <description>Clinical assessment to diagnose generalized epileptic seizure</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Incidence of vasospasm</measure>
    <time_frame>Up to one week postoperatively</time_frame>
    <description>Flow velocity over middle cerebral artery more than 180 cm/s measured by transcranial ultrasound</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Incidence of pathological computerized tomography brain scan</measure>
    <time_frame>Up to one week postoperatively</time_frame>
    <description>Findings of edema, ischemia, bleeding or hydrocephalus on brain CT scan</description>
  </secondary_outcome>
  <other_outcome>
    <measure>Incidence of meningitis, pneumonia and sepsis</measure>
    <time_frame>Up to one week postoperatively</time_frame>
    <description>Clinical signs and laboratory findings for diagnosing infectious complications</description>
  </other_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Anticipated">40</enrollment>
  <condition>Aneurysm, Cerebral</condition>
  <arm_group>
    <arm_group_label>Lidocaine group</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Participants in lidocaine group, following induction to general anesthesia, will have lidocaine 2% 4 mg/kg administered as regional anesthesia of the scalp prior to Mayfield frame placement and lidocaine 1% 40 mg topically to the throat prior to direct laryngoscopy and endotracheal intubation. Maximum dosage of lidocaine won't exceed 400 mg.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Control group</arm_group_label>
    <arm_group_type>No Intervention</arm_group_type>
    <description>Participants in control group will have general anesthesia without lidocaine administration.</description>
  </arm_group>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Lidocaine</intervention_name>
    <description>Administration of lidocaine 2% 4 mg/kg administered as regional anesthesia of the scalp prior to Mayfield frame placement and lidocaine 1% 40 mg topically to the throat prior to direct laryngoscopy and endotracheal intubation.</description>
    <arm_group_label>Lidocaine group</arm_group_label>
    <other_name>Regional anesthesia</other_name>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  ASA ( American Society of Anesthesiologists) grading status I-III,&#xD;
&#xD;
          -  scheduled for cerebral aneurysm surgery under general anesthesia,&#xD;
&#xD;
          -  signed informed consent for participating in the research.&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  poorly controlled chronic or acute cardiovascular, respiratory or autoimmune disease,&#xD;
&#xD;
          -  acute infectious disease,&#xD;
&#xD;
          -  renal or hepatic insufficiency,&#xD;
&#xD;
          -  preoperative Glasgow Coma Scale score lower than 15,&#xD;
&#xD;
          -  allergic reaction to any of the medications in protocol,&#xD;
&#xD;
          -  pregnancy&#xD;
&#xD;
          -  refusal to participate in the research.&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>70 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <location>
    <facility>
      <name>UHCZagreb</name>
      <address>
        <city>Zagreb</city>
        <zip>10000</zip>
        <country>Croatia</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Croatia</country>
  </location_countries>
  <reference>
    <citation>Chaki T, Sugino S, Janicki PK, Ishioka Y, Hatakeyama Y, Hayase T, Kaneuchi-Yamashita M, Kohri N, Yamakage M. Efficacy and Safety of a Lidocaine and Ropivacaine Mixture for Scalp Nerve Block and Local Infiltration Anesthesia in Patients Undergoing Awake Craniotomy. J Neurosurg Anesthesiol. 2016 Jan;28(1):1-5. doi: 10.1097/ANA.0000000000000149.</citation>
    <PMID>25493926</PMID>
  </reference>
  <reference>
    <citation>Guilfoyle MR, Helmy A, Duane D, Hutchinson PJA. Regional scalp block for postcraniotomy analgesia: a systematic review and meta-analysis. Anesth Analg. 2013 May;116(5):1093-1102. doi: 10.1213/ANE.0b013e3182863c22. Epub 2013 Mar 11.</citation>
    <PMID>23477962</PMID>
  </reference>
  <reference>
    <citation>Leng T, Gao X, Dilger JP, Lin J. Neuroprotective effect of lidocaine: is there clinical potential? Int J Physiol Pathophysiol Pharmacol. 2016 Apr 25;8(1):9-13. eCollection 2016.</citation>
    <PMID>27186318</PMID>
  </reference>
  <reference>
    <citation>Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology. 2000 Sep;93(3):858-75. doi: 10.1097/00000542-200009000-00038. No abstract available.</citation>
    <PMID>10969322</PMID>
  </reference>
  <reference>
    <citation>Jeong HJ, Lin D, Li L, Zuo Z. Delayed treatment with lidocaine reduces mouse microglial cell injury and cytokine production after stimulation with lipopolysaccharide and interferon gamma. Anesth Analg. 2012 Apr;114(4):856-61. doi: 10.1213/ANE.0b013e3182460ab5. Epub 2012 Jan 16.</citation>
    <PMID>22253275</PMID>
  </reference>
  <reference>
    <citation>Pawlowska E, Szczepanska J, Wisniewski K, Tokarz P, Jaskolski DJ, Blasiak J. NF-kappaB-Mediated Inflammation in the Pathogenesis of Intracranial Aneurysm and Subarachnoid Hemorrhage. Does Autophagy Play a Role? Int J Mol Sci. 2018 Apr 19;19(4):1245. doi: 10.3390/ijms19041245.</citation>
    <PMID>29671828</PMID>
  </reference>
  <reference>
    <citation>Aoki T, Nishimura M. Targeting chronic inflammation in cerebral aneurysms: focusing on NF-kappaB as a putative target of medical therapy. Expert Opin Ther Targets. 2010 Mar;14(3):265-73. doi: 10.1517/14728221003586836.</citation>
    <PMID>20128708</PMID>
  </reference>
  <reference>
    <citation>Mutlu LK, Woiciechowsky C, Bechmann I. Inflammatory response after neurosurgery. Best Pract Res Clin Anaesthesiol. 2004 Sep;18(3):407-24. doi: 10.1016/j.bpa.2003.12.003.</citation>
    <PMID>15212336</PMID>
  </reference>
  <reference>
    <citation>Chaudhry SR, Stoffel-Wagner B, Kinfe TM, Guresir E, Vatter H, Dietrich D, Lamprecht A, Muhammad S. Elevated Systemic IL-6 Levels in Patients with Aneurysmal Subarachnoid Hemorrhage Is an Unspecific Marker for Post-SAH Complications. Int J Mol Sci. 2017 Dec 1;18(12):2580. doi: 10.3390/ijms18122580.</citation>
    <PMID>29194369</PMID>
  </reference>
  <reference>
    <citation>Osborn I, Sebeo J. &quot;Scalp block&quot; during craniotomy: a classic technique revisited. J Neurosurg Anesthesiol. 2010 Jul;22(3):187-94. doi: 10.1097/ANA.0b013e3181d48846.</citation>
    <PMID>20479675</PMID>
  </reference>
  <reference>
    <citation>Hopkins SJ, McMahon CJ, Singh N, Galea J, Hoadley M, Scarth S, Patel H, Vail A, Hulme S, Rothwell NJ, King AT, Tyrrell PJ. Cerebrospinal fluid and plasma cytokines after subarachnoid haemorrhage: CSF interleukin-6 may be an early marker of infection. J Neuroinflammation. 2012 Nov 23;9:255. doi: 10.1186/1742-2094-9-255.</citation>
    <PMID>23176037</PMID>
  </reference>
  <verification_date>November 2020</verification_date>
  <study_first_submitted>January 24, 2019</study_first_submitted>
  <study_first_submitted_qc>January 29, 2019</study_first_submitted_qc>
  <study_first_posted type="Actual">January 30, 2019</study_first_posted>
  <last_update_submitted>November 10, 2020</last_update_submitted>
  <last_update_submitted_qc>November 10, 2020</last_update_submitted_qc>
  <last_update_posted type="Actual">November 12, 2020</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Clinical Hospital Centre Zagreb</investigator_affiliation>
    <investigator_full_name>Marijana Matas</investigator_full_name>
    <investigator_title>Principal Investigator</investigator_title>
  </responsible_party>
  <keyword>aneurysm, cerebral</keyword>
  <keyword>inflammation mediators</keyword>
  <keyword>lidocaine, hydrochloride</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Intracranial Aneurysm</mesh_term>
    <mesh_term>Aneurysm</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Lidocaine</mesh_term>
  </intervention_browse>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03823482
org study id: 51
nct id: NCT03823482
lead sponsor: 
is fda regulated drug: No
is fda regulated device: No
Cerebral aneurysm surgery has significant mortality and morbidity rate. Inflammation plays a
      key role in the pathogenesis of intracranial aneurysms, their rupture, subarachnoid
      haemorrhage and neurologic complications. Brain injury activates immune cells and triggers
      cytokine release. Cytokine level in blood and cerebrospinal fluid is an indicator of
      inflammatory response. Cytokines contribute to secondary brain injury and can worsen the
      outcome of the treatment. Preventing secondary brain injury by modulating inflammatory
      response represents a therapeutic target. Lidocaine is local anesthetic that can be used in
      neurosurgery for regional anesthesia of the scalp and for topical anesthesia of the throat
      prior to direct laryngoscopy and endotracheal intubation. Except analgetic, lidocaine has
      systemic anti-inflammatory and neuroprotective effect. It acts through several mechanisms on
      various types of immune cells producing immunosuppressing effect. Lidocaine can act on
      activated microglia within central nervous system causing attenuation of immune response.

      Primary aim of this prospective randomized trial is to determine influence of lidocaine
      administration on inflammatory cytokine levels in serum and cerebrospinal fluid during and
      following cerebral aneurysm surgery. Secondary aim is to determine possible correlation
      between levels of cytokines and incidence of neurologic and infectious postoperative
      complications. For that purpose, postoperative neurological clinical status will be recorded.
      Signs of vasospasm and pathological postoperative brain CT scan findings will be recorded.
      Incidence of meningitis, pneumonia and sepsis in postoperative period will also be analyzed.

      Hypothesis of this trial is that lidocaine administration during cerebral aneurysm surgery
      would significantly change levels of pro-inflammatory cytokines in cerebrospinal fluid and
      serum. Lower concentrations of pro-inflammatory cytokines can possibly contribute to better
      outcome and significantly lower incidence of postoperative complications.
      Enzyme-immunochemical analysis will be used to measure levels of interleukin-1β,
      interleukin-6 and tumor necrosis factor-α in cerebrospinal fluid and serum. Investigation
      group will have, during cerebrovascular surgery under general anesthesia, regional anesthesia
      of the scalp and topical anesthesia of the throat prior to laryngoscopy, all done with
      lidocaine. Control group will have general anesthesia without lidocaine administration.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Other
masking: None (Open Label)
measure: Change in concentrations of interleukin-1β
time frame: Up to 24 hours after anesthesia induction.
description: Concentrations of IL-1β in pg/ml in cerebrospinal fluid and serum measured by enzyme-linked immunosorbent assay
measure: Change in concentrations of interleukin-6
time frame: Up to 24 hours after anesthesia induction.
description: Concentrations of IL-6 in pg/ml in cerebrospinal fluid and serum measured by enzyme-linked immunosorbent assay
measure: Change in concentrations of tumor necrosis factor α
time frame: Up to 24 hours after anesthesia induction.
description: Concentrations of TNF-α in pg/ml in cerebrospinal fluid and serum measured by enzyme-linked immunosorbent assay
measure: Incidence of new motoric deficit
time frame: Up to one week postoperatively
description: Clinical assessment of neurologic status incidence of generalized epileptic seizure, incidence of vasospasm, pathological finding on brain computerized tomography ( ischemia, edema, bleeding, hydrocephalus).
measure: Incidence of generalized epileptic seizure
time frame: Up to one week postoperatively
description: Clinical assessment to diagnose generalized epileptic seizure
measure: Incidence of vasospasm
time frame: Up to one week postoperatively
description: Flow velocity over middle cerebral artery more than 180 cm/s measured by transcranial ultrasound
measure: Incidence of pathological computerized tomography brain scan
time frame: Up to one week postoperatively
description: Findings of edema, ischemia, bleeding or hydrocephalus on brain CT scan
measure: Incidence of meningitis, pneumonia and sepsis
time frame: Up to one week postoperatively
description: Clinical signs and laboratory findings for diagnosing infectious complications
arm group label: Lidocaine group
arm group type: Experimental
description: Participants in lidocaine group, following induction to general anesthesia, will have lidocaine 2% 4 mg/kg administered as regional anesthesia of the scalp prior to Mayfield frame placement and lidocaine 1% 40 mg topically to the throat prior to direct laryngoscopy and endotracheal intubation. Maximum dosage of lidocaine won't exceed 400 mg.
arm group label: Control group
arm group type: No Intervention
description: Participants in control group will have general anesthesia without lidocaine administration.
intervention type: Drug
intervention name: Lidocaine
description: Administration of lidocaine 2% 4 mg/kg administered as regional anesthesia of the scalp prior to Mayfield frame placement and lidocaine 1% 40 mg topically to the throat prior to direct laryngoscopy and endotracheal intubation.
arm group label: Lidocaine group
other name: Regional anesthesia
criteria: 
gender: All
minimum age: 18 Years
maximum age: 70 Years
healthy volunteers: No
facility: 
country: Croatia
citation: Chaki T, Sugino S, Janicki PK, Ishioka Y, Hatakeyama Y, Hayase T, Kaneuchi-Yamashita M, Kohri N, Yamakage M. Efficacy and Safety of a Lidocaine and Ropivacaine Mixture for Scalp Nerve Block and Local Infiltration Anesthesia in Patients Undergoing Awake Craniotomy. J Neurosurg Anesthesiol. 2016 Jan;28(1):1-5. doi: 10.1097/ANA.0000000000000149.
PMID: 25493926
citation: Guilfoyle MR, Helmy A, Duane D, Hutchinson PJA. Regional scalp block for postcraniotomy analgesia: a systematic review and meta-analysis. Anesth Analg. 2013 May;116(5):1093-1102. doi: 10.1213/ANE.0b013e3182863c22. Epub 2013 Mar 11.
PMID: 23477962
citation: Leng T, Gao X, Dilger JP, Lin J. Neuroprotective effect of lidocaine: is there clinical potential? Int J Physiol Pathophysiol Pharmacol. 2016 Apr 25;8(1):9-13. eCollection 2016.
PMID: 27186318
citation: Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology. 2000 Sep;93(3):858-75. doi: 10.1097/00000542-200009000-00038. No abstract available.
PMID: 10969322
citation: Jeong HJ, Lin D, Li L, Zuo Z. Delayed treatment with lidocaine reduces mouse microglial cell injury and cytokine production after stimulation with lipopolysaccharide and interferon gamma. Anesth Analg. 2012 Apr;114(4):856-61. doi: 10.1213/ANE.0b013e3182460ab5. Epub 2012 Jan 16.
PMID: 22253275
citation: Pawlowska E, Szczepanska J, Wisniewski K, Tokarz P, Jaskolski DJ, Blasiak J. NF-kappaB-Mediated Inflammation in the Pathogenesis of Intracranial Aneurysm and Subarachnoid Hemorrhage. Does Autophagy Play a Role? Int J Mol Sci. 2018 Apr 19;19(4):1245. doi: 10.3390/ijms19041245.
PMID: 29671828
citation: Aoki T, Nishimura M. Targeting chronic inflammation in cerebral aneurysms: focusing on NF-kappaB as a putative target of medical therapy. Expert Opin Ther Targets. 2010 Mar;14(3):265-73. doi: 10.1517/14728221003586836.
PMID: 20128708
citation: Mutlu LK, Woiciechowsky C, Bechmann I. Inflammatory response after neurosurgery. Best Pract Res Clin Anaesthesiol. 2004 Sep;18(3):407-24. doi: 10.1016/j.bpa.2003.12.003.
PMID: 15212336
citation: Chaudhry SR, Stoffel-Wagner B, Kinfe TM, Guresir E, Vatter H, Dietrich D, Lamprecht A, Muhammad S. Elevated Systemic IL-6 Levels in Patients with Aneurysmal Subarachnoid Hemorrhage Is an Unspecific Marker for Post-SAH Complications. Int J Mol Sci. 2017 Dec 1;18(12):2580. doi: 10.3390/ijms18122580.
PMID: 29194369
citation: Osborn I, Sebeo J. "Scalp block" during craniotomy: a classic technique revisited. J Neurosurg Anesthesiol. 2010 Jul;22(3):187-94. doi: 10.1097/ANA.0b013e3181d48846.
PMID: 20479675
citation: Hopkins SJ, McMahon CJ, Singh N, Galea J, Hoadley M, Scarth S, Patel H, Vail A, Hulme S, Rothwell NJ, King AT, Tyrrell PJ. Cerebrospinal fluid and plasma cytokines after subarachnoid haemorrhage: CSF interleukin-6 may be an early marker of infection. J Neuroinflammation. 2012 Nov 23;9:255. doi: 10.1186/1742-2094-9-255.
PMID: 23176037
responsible party type: Principal Investigator
investigator affiliation: Clinical Hospital Centre Zagreb
investigator full name: Marijana Matas
investigator title: Principal Investigator
mesh term: Intracranial Aneurysm
mesh term: Aneurysm
mesh term: Lidocaine