{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T03:45:04Z","timestamp":1794368704886,"version":"4.9.0"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T00:00:00Z","timestamp":1612396800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T00:00:00Z","timestamp":1612396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Polyganics b.v."}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Childs Nerv Syst"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cerebrospinal fluid (CSF) leakage is a common complication after neurosurgical intervention. It is associated with substantial morbidity and increased\u00a0healthcare costs. The current systematic review and meta-analysis aim to quantify the incidence of cerebrospinal fluid leakage in the pediatric population\u00a0and identify its risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors followed the PRISMA guidelines. The Embase, PubMed, and Cochrane database were searched for studies reporting CSF leakage after\u00a0intradural cranial surgery in patients up to 18 years old. Meta-analysis of incidences was performed using a generalized linear mixed model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-six articles were included in this systematic review. Data were retrieved of 2929 patients who underwent a total of 3034 intradural cranial surgeries.\u00a0Surprisingly, only four of the included articles reported their definition of CSF leakage. The overall CSF leakage rate was 4.4% (95% CI 2.6 to 7.3%). The\u00a0odds of CSF leakage were significantly greater for craniectomy as opposed to craniotomy (OR 4.7, 95% CI 1.7 to 13.4) and infratentorial as opposed to\u00a0supratentorial surgery (OR 5.9, 95% CI 1.7 to 20.6). The odds of CSF leakage were significantly lower for duraplasty use versus no duraplasty (OR 0.41\u00a095% CI 0.2 to 0.9).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The overall CSF leakage rate after intradural cranial surgery in the pediatric population is 4.4%. Risk factors are craniectomy and infratentorial surgery.\u00a0Duraplasty use is negatively associated with CSF leak. We suggest defining a CSF leak as \u201cleakage of CSF through the skin,\u201d as an unambiguous definition\u00a0is fundamental for future research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00381-021-05036-8","type":"journal-article","created":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T11:13:06Z","timestamp":1612437186000},"page":"1439-1447","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Cerebrospinal fluid leakage after cranial surgery in the pediatric population\u2014a systematic review and meta-analysis"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4296-1331","authenticated-orcid":false,"given":"Emma M. H.","family":"Slot","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten M.","family":"van Baarsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eelco W.","family":"Hoving","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolaas P. A.","family":"Zuithoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan P. C","family":"van Doormaal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,4]]},"reference":[{"key":"5036_CR1","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1016\/j.wneu.2017.07.034","volume":"106","author":"F Behling","year":"2017","unstructured":"Behling F, Kaltenstadler M, Noell S et al (2017) The prognostic impact of ventricular opening in glioblastoma surgery: a retrospective single center analysis. World Neurosurg. 106:615\u2013624","journal-title":"World Neurosurg."},{"issue":"5-6","key":"5036_CR2","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1007\/s00381-003-0745-x","volume":"19","author":"L Bogn\u00e1r","year":"2003","unstructured":"Bogn\u00e1r L, Borgulya G, Benke P, Madarassy G (2003) Analysis of CSF shunting procedure requirement in children with posterior fossa tumors. Child\u2019s Nerv Syst. 19(5-6):332\u2013336","journal-title":"Child\u2019s Nerv Syst."},{"key":"5036_CR3","doi-asserted-by":"publisher","first-page":"817","DOI":"10.3171\/jns.1983.59.5.0817","volume":"59","author":"ER Cardoso","year":"1983","unstructured":"Cardoso ER, Rowan JO, Galbraith S (1983) Analysis of the cerebrospinal fluid pulse wave in intracranial pressure. J Neurosurg. 59:817\u2013821","journal-title":"J Neurosurg."},{"issue":"1","key":"5036_CR4","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1159\/000120761","volume":"20","author":"DD Cochrane","year":"1994","unstructured":"Cochrane DD, Gustavsson B, Poskitt KP et al (1994) The surgical and natural morbidity of aggressive resection for posterior fossa tumors in childhood. Pediatr Neurosurg. 20(1):19\u201329","journal-title":"Pediatr Neurosurg."},{"issue":"3","key":"5036_CR5","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1227\/00006123-199403000-00003","volume":"34","author":"DJ Culley","year":"1994","unstructured":"Culley DJ, Berger MS, Shaw D et al (1994) An analysis of factors determining the need for ventriculoperitoneal shunts after posterior fossa tumor surgery in children. Neurosurg. 34(3):402\u2013408","journal-title":"Neurosurg."},{"issue":"1","key":"5036_CR6","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3171\/2014.10.PEDS1430","volume":"15","author":"BJ Dlouhy","year":"2015","unstructured":"Dlouhy BJ, Chae MP, Teo C (2015) The supraorbital eyebrow approach in children: clinical outcomes, cosmetic results, and complications. J Neurosurg Pediatr. 15(1):12\u201319","journal-title":"J Neurosurg Pediatr."},{"issue":"4","key":"5036_CR7","doi-asserted-by":"publisher","first-page":"821","DOI":"10.3171\/jns.2002.97.4.0821","volume":"97","author":"KK Gananalignham","year":"2002","unstructured":"Gananalignham KK, Lafuente J, Thompson D et al (2002) Surgical procedures for posterior fossa tumors in children: does craniotomy lead to fewer complications than craniectomy? J Neurosurg. 97(4):821\u2013826","journal-title":"J Neurosurg."},{"issue":"6","key":"5036_CR8","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1080\/02688690310001627777","volume":"17","author":"KK Gananalignham","year":"2003","unstructured":"Gananalignham KK, Lafuente J, Thompson D et al (2003) MRI study of the natural history and risk factors for pseudomeningocoele formation following postfossa surgery in children. Br J Neurosurg. 17(6):530\u2013536","journal-title":"Br J Neurosurg."},{"issue":"2","key":"5036_CR9","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1159\/000343009","volume":"48","author":"CV Gopalakrishnan","year":"2012","unstructured":"Gopalakrishnan CV, Dhakoji A, Menon G et al (2012) Factors predicting the need for cerebrospinal fluid diversion following posterior fossa tumor surgery in children. Pediatr Neurosurg. 48(2):93\u2013101","journal-title":"Pediatr Neurosurg."},{"issue":"6","key":"5036_CR10","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1016\/j.surneu.2005.03.041","volume":"64","author":"JA Grotenhuis","year":"2005","unstructured":"Grotenhuis JA (2005) Costs of postoperative cerebrospinal fluid leakage: 1-Year, retrospective analysis of 412 consecutive nontrauma cases. Surg Neurol. 64(6):490\u2013493","journal-title":"Surg Neurol."},{"issue":"3","key":"5036_CR11","doi-asserted-by":"publisher","first-page":"228","DOI":"10.3171\/2019.9.PEDS1939","volume":"25","author":"AT Hale","year":"2020","unstructured":"Hale AT, Gannon SR, Zhao S et al (2020) Graft dural closure is associated with a reduction in CSF leak and hydrocephalus in pediatric patients undergoing posterior fossa brain tumor resection. J Neurosurg Pediatr. 25(3):228\u2013234","journal-title":"J Neurosurg Pediatr."},{"key":"5036_CR12","doi-asserted-by":"publisher","first-page":"e544","DOI":"10.1016\/j.wneu.2018.06.073","volume":"117","author":"ET Hidalgo","year":"2018","unstructured":"Hidalgo ET, Dastagirzada Y, Orillac C et al (2018) Time to resolution of symptoms after suboccipital decompression with duraplasty in children with chiari malformation type I. World Neurosurg. 117:e544\u2013e551","journal-title":"World Neurosurg."},{"issue":"11","key":"5036_CR13","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","volume":"21","author":"JPT Higgins","year":"2002","unstructured":"Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med. 21(11):1539\u20131558","journal-title":"Stat Med."},{"issue":"6","key":"5036_CR14","doi-asserted-by":"publisher","first-page":"604","DOI":"10.3171\/2014.8.PEDS13585","volume":"14","author":"SAM Hosainey","year":"2014","unstructured":"Hosainey SAM, Lassen B, Helseth E, Meling TR (2014) Cerebrospinal fluid disturbances after 381 consecutive craniotomies for intracranial tumors in pediatric patients. J Neurosurg Pediatr. 14(6):604\u2013614","journal-title":"J Neurosurg Pediatr."},{"issue":"6","key":"5036_CR15","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1007\/s00381-010-1373-x","volume":"27","author":"SP Houdemont","year":"2011","unstructured":"Houdemont SP, De Carli E, Delion M et al (2011) Short-term neurological outcome of children after surgery for brain tumors: incidence and characteristics in a pediatric intensive care unit. Child\u2019s Nerv Syst. 27(6):933\u2013941","journal-title":"Child\u2019s Nerv Syst."},{"issue":"3","key":"5036_CR16","doi-asserted-by":"publisher","first-page":"735","DOI":"10.3171\/2014.6.JNS131917","volume":"121","author":"G Hutter","year":"2014","unstructured":"Hutter G, Von Felten S, Sailer MH, Schulz M, Mariani L (2014) Risk factors for postoperative CSF leakage after elective craniotomy and the efficacy of fleece-bound tissue sealing against dural suturing alone: a randomized controlled trial - clinical article. J Neurosurg. 121(3):735\u2013744","journal-title":"J Neurosurg."},{"key":"5036_CR17","doi-asserted-by":"publisher","first-page":"e465","DOI":"10.1016\/j.wneu.2017.11.007","volume":"110","author":"E Jiang","year":"2018","unstructured":"Jiang E, Sha S, Yuan X et al (2018) Comparison of clinical and radiographic outcomes for posterior fossa decompression with and without duraplasty for treatment of pediatric chiari I malformation: a prospective study. World Neurosurg. 110:e465\u2013e472","journal-title":"World Neurosurg."},{"key":"5036_CR18","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1016\/j.wneu.2018.06.196","volume":"118","author":"A Kinaci","year":"2018","unstructured":"Kinaci A, Algra A, Heuts S, O\u2019Donnell D, van der Zwan A, van Doormaal T (2018) Effectiveness of dural sealants in prevention of cerebrospinal fluid leakage after craniotomy: a systematic review. World Neurosurg 118:368\u2013376.e1","journal-title":"World Neurosurg"},{"issue":"3","key":"5036_CR19","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1159\/000028777","volume":"30","author":"MD Krieger","year":"1999","unstructured":"Krieger MD, McComb JG, Levy ML (1999) Toward a simpler surgical management of Chiari I malformation in a pediatric population. Pediatr Neurosurg. 30(3):113\u2013121","journal-title":"Pediatr Neurosurg."},{"key":"5036_CR20","doi-asserted-by":"publisher","first-page":"e171","DOI":"10.1016\/j.wneu.2019.05.091","volume":"129","author":"Y Kushel","year":"2019","unstructured":"Kushel Y, Danilov G, Tekoev A et al (2019) A single-center retrospective descriptive cohort study of 211 pediatric patients: cerebrospinal fluid leakage after fourth ventricle tumor resection. World Neurosurg. 129:e171\u2013e176","journal-title":"World Neurosurg."},{"issue":"4","key":"5036_CR21","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1227\/NEU.0b013e31823bcc61","volume":"70","author":"B Lassen","year":"2012","unstructured":"Lassen B, Helseth E, Egge A et al (2012) Surgical mortality and selected complications in 273 consecutive craniotomies for intracranial tumors in pediatric patients. Neurosurgery. 70(4):936\u2013943","journal-title":"Neurosurgery."},{"issue":"3","key":"5036_CR22","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/j.jpeds.2012.09.012","volume":"162","author":"E Leclercq","year":"2013","unstructured":"Leclercq E, Leeflang MMG, van Dalen EC et al (2013) Validation of search filters for identifying pediatric studies in PubMed. J Pediatr. 162(3):629\u2013634.e2","journal-title":"J Pediatr."},{"issue":"5","key":"5036_CR23","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1227\/01.NEU.0000089060.65702.03","volume":"53","author":"M Levy","year":"2003","unstructured":"Levy M, Wang M, Aryan HE et al (2003) Microsurgical keyhole approach for Mmiddle fossa arachnoid cyst fenestration. Neurosurgery. 53(5):1138\u20131145","journal-title":"Neurosurgery."},{"key":"5036_CR24","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.otohns.2004.01.018","volume":"131","author":"NH Mehendale","year":"2004","unstructured":"Mehendale NH, Samy RN, Roland PS (2004) Management of pseudomeningocele following neurotologic procedures. Otolaryngol Head Neck Surg. 131:253\u2013262","journal-title":"Otolaryngol Head Neck Surg."},{"issue":"7","key":"5036_CR25","doi-asserted-by":"publisher","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","volume":"6","author":"D Moher","year":"2009","unstructured":"Moher D, Liberati A, Tetzlaff J et al (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. PLOS Med. 6(7):e1000097","journal-title":"PLOS Med."},{"issue":"4","key":"5036_CR26","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1159\/000120840","volume":"21","author":"CA Muszynski","year":"1994","unstructured":"Muszynski CA, Laurent JP, Cheek WR (1994) Effects of ventricular drainage and dural closure on cerebrospinal fluid leaks after posterior fossa tumor surgery. Pediatr Neurosurg. 21(4):227\u2013231","journal-title":"Pediatr Neurosurg."},{"key":"5036_CR27","unstructured":"National Institutes of Health. Study quality assessment tools | National Heart, Lung, and Blood Institute (NHLBI). Natl Institutes Heal. 2014. https:\/\/www.nhlbi.nih.gov\/health-topics\/study-quality-assessment-tools. Accessed January 14, 2020."},{"issue":"11","key":"5036_CR28","doi-asserted-by":"publisher","first-page":"2115","DOI":"10.1007\/s00701-012-1457-3","volume":"154","author":"M Panigrahi","year":"2012","unstructured":"Panigrahi M, Krishnan SS, Varma DR (2012) Crescent posterior fossa durotomy for occipito-marginal venous sinus preservation: a pilot study. Acta Neurochir (Wien). 154(11):2115\u20132121","journal-title":"Acta Neurochir (Wien)."},{"issue":"9","key":"5036_CR29","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1007\/s003810050255","volume":"14","author":"J Parizek","year":"1998","unstructured":"Parizek J, Mericka P, Nemecek S et al (1998) Posterior cranial fossa surgery in 454 children: comparison of results obtained in pre-CT and CT era and after various types of management of dura mater. Child\u2019s Nerv Syst. 14(9):426\u2013438","journal-title":"Child\u2019s Nerv Syst."},{"issue":"2","key":"5036_CR30","doi-asserted-by":"publisher","first-page":"177","DOI":"10.3171\/2011.5.PEDS10362","volume":"8","author":"SR Parker","year":"2011","unstructured":"Parker SR, Harris P, Cummings TJ et al (2011) Complications following decompression of Chiari malformation type I in children: dural graft or sealant? Clinical article. J Neurosurg Pediatr. 8(2):177\u2013183","journal-title":"J Neurosurg Pediatr."},{"issue":"9","key":"5036_CR31","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1007\/s003810100496","volume":"17","author":"CH Rickert","year":"2001","unstructured":"Rickert CH, Paulus W (2001) Epidemiology of central nervous system tumors in childhood and adolescence based on the new WHO classification. Child\u2019s Nerv Syst. 17(9):503\u2013511","journal-title":"Child\u2019s Nerv Syst."},{"key":"5036_CR32","doi-asserted-by":"publisher","first-page":"e743","DOI":"10.1016\/j.wneu.2018.03.070","volume":"114","author":"J Roth","year":"2018","unstructured":"Roth J, Benvenisti H, Constantini S (2018) Watertight dural closure in pediatric craniotomies\u2014is it really necessary? World Neurosurg. 114:e743\u2013e746","journal-title":"World Neurosurg."},{"issue":"3","key":"5036_CR33","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s00381-018-04039-2","volume":"35","author":"J Soleman","year":"2019","unstructured":"Soleman J, Ber R, Constantini S, Roth J (2019) The interhemispheric approach in children: our experience and review of the literature. Childs Nerv Syst. 35(3):445\u2013452","journal-title":"Childs Nerv Syst."},{"issue":"5","key":"5036_CR34","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1159\/000028805","volume":"30","author":"J Srinivasan","year":"1999","unstructured":"Srinivasan J, Dailey AT, Berger MS (1999) The bifrontal olfactory nerve-sparing approach to lesions of the suprasellar region in children. Pediatr Neurosurg. 30(5):245\u2013252","journal-title":"Pediatr Neurosurg."},{"issue":"2","key":"5036_CR35","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1007\/s00381-006-0234-0","volume":"23","author":"P Steinbok","year":"2007","unstructured":"Steinbok P, Singhal A, Mills J et al (2007) Cerebrospinal fluid (CSF) leak and pseudomeningocele formation after posterior fossa tumor resection in children: a retrospective analysis. Child\u2019s Nerv Syst. 23(2):171\u2013174","journal-title":"Child\u2019s Nerv Syst."},{"key":"5036_CR36","doi-asserted-by":"publisher","first-page":"1791","DOI":"10.1007\/s00381-014-2501-9","volume":"30","author":"A Tu","year":"2014","unstructured":"Tu A, Tamburrini G, Steinbok P (2014) Management of postoperative pseudomeningoceles: an international survey study. Childs Nerv Syst 30:1791\u20131801","journal-title":"Childs Nerv Syst"},{"issue":"3","key":"5036_CR37","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1007\/s00381-017-3639-z","volume":"34","author":"A Vedantam","year":"2018","unstructured":"Vedantam A, Pan IW, Staggers KA, Lam SK (2018) Thirty-day outcomes in pediatric epilepsy surgery. Child\u2019s Nerv Syst. 34(3):487\u2013494","journal-title":"Child\u2019s Nerv Syst."},{"issue":"5","key":"5036_CR38","doi-asserted-by":"publisher","first-page":"514","DOI":"10.3171\/2014.7.PEDS1437","volume":"14","author":"X Zhou","year":"2014","unstructured":"Zhou X, Goodwin CR, Recinos PF et al (2014) Evaluation of complication rates of pediatric cranial procedures in which a polyethylene glycol sealant was used. J Neurosurg Pediatr. 14(5):514\u2013517","journal-title":"J Neurosurg Pediatr."}],"container-title":["Child's Nervous System"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-021-05036-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00381-021-05036-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-021-05036-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T05:15:39Z","timestamp":1619673339000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00381-021-05036-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,4]]},"references-count":38,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["5036"],"URL":"https:\/\/doi.org\/10.1007\/s00381-021-05036-8","relation":{},"ISSN":["0256-7040","1433-0350"],"issn-type":[{"value":"0256-7040","type":"print"},{"value":"1433-0350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,4]]},"assertion":[{"value":"2 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"TPC van Doormaal is a consultant for Polyganics B.V.Polyganics B.V. was not involved in the content of this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Not applicable.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code availability"}}]}}