GLOBAL NEWS

Neuroanesthesia in Belgium 

Veerle De Sloovere, MD
Department of Anaesthesiology, University Hospitals Leuven
Belgium 

Vincent Bonhomme, MD, PhD
Chair, Departement d’Anesthesie-Reanimation Centre Hospitalier Universitaire de Liège
Belgium 

 Belgium, also known as “Brussels,” is a small (30.528km2) West-European country centered between London, Paris, Amsterdam, and Berlin a bit further away. The capital is Brussels, also the administrative center of the European Union (EU). There are approximately 11.7 million inhabitants, with three official languages French, Dutch, and German. With 376 inhabitants per square kilometer, it is one of the most densely populated countries in Europe. We’re a small country with not as much capabilities as bigger countries. The three official languages do not make it any easier either. Fifteen percent of the population is older than 65 years. Life expectancy is 79 years for males and 83 years for females. Some rankings consider the quality of the Belgian health care system to be among the best in the world. But there is still some room for improvement. 

To understand the organization of Belgium’s Health care and neuro-anesthesia and critical care, in particular, I need to explain a bit of the origin of Belgium. During the previous centuries, we’ve been “visited” by multiple superpowers: the Romans, the Celts, the Austrians, the Spanish, the French, the Dutch, etc. 

Shortly after the outbreak of riots in Brussels in 1830, Belgium was declared independent. Some say this happened by accident. Cultural and linguistic differences between different parts of the country have led to a series of state reforms and resulted in a complex political system and, consequently, a complex healthcare system with 9 (nine) ministers of health care. This makes decision processes in our health care system often laborious. There are seven academic hospitals spread over the country and approximately 65 non-academic hospitals that offer neurosurgical services. This ensures good coverage of specialized neurosurgical care across Belgian territory, close to home for patients. A wide variety of neurosurgical and neuro-radiological interventions, both axial and intracranial, neurovascular, functional neurosurgery, complex spine, and awake procedures, are offered. The more complex procedures are more centered in, the larger centers, often academic centers. 

Neurosurgery and neuroanesthesia 

Neuro-anesthesia and neuro-critical care are closely linked with neurosurgery. There is no government-organized neurosurgical care in Belgium, as in the Netherlands, for example. All Belgian hospitals are allowed to perform neurosurgical procedures. The only two exceptions are deep brain stimulation and epilepsy surgery. Deep brain stimulation is allowed with special accreditation. Epilepsy surgery is limited to 4 expertise centers. There are 11 interventional neuroradiology centers in Flanders, and the same number in Wallonia, providing a full interventional neuroradiology service.  

This system gives doctors a certain amount of therapeutic freedom and allows the patients to choose a doctor close to home. A potential drawback of these liberal policies is an unequal distribution of caseload and experience in certain procedures, both for neurosurgery and anesthesia. 

Anaesthesia and Neuro-anaesthesia Training 

Full anesthesia training lasts five years and provides the title of specialist in anesthesia and resuscitation. The only two recognized anesthesia subspecialties are intensive care medicine and emergency medicine. All other subspecialties, for example, neuro-anesthesia, are not recognized by the government, like in many other countries.   

In recent years, we have noticed an increasing demand for training in neuro-anesthesia training and for neuro-anesthesiologists in academic and non-academic hospitals. These candidates attend renowned international centers like the National Hospital for Neurology and Neurosurgery, London, United Kingdom, or Toronto Western Hospital, Toronto, Canada. This increasing demand for neuro-anesthesia and neuro-critical care knowledge follows the increasing trend of complex neurosurgical and neuroradiology procedures and the increasing complexity in neuro-critical care. Due to the fact that the older age category (+65 years) is strongly represented in Belgium and the high life expectancy, there is also an increase in neurodegenerative and neurovascular diseases. 

National formation in neuroanesthesia and neuro-critical care 

In 1998, the first EURONEURO meeting was organized by Cathy De Deyne, René Heylen, and Raf De Jong (East-Limburg Hospital, Genk, Belgium). This meeting for neuro-anaesthesiologists, neurosurgeons, neuro-intensive care specialists, and neurologists still takes place every two years in various European countries. Despite the long existence of this reputable organization, there’s no national neuro-anesthesia society. Anaesthesiologists from Wallonia are in close contact with the ANARLF (l’Association de Neuro-Anesthesie-Reanimation de Langue Françiase), while in Flanders, neuro-anesthesiologists tend to associate with the Anglo-Saxon associations, as for example SNACC. 

There is a close collaboration between Belgian IC specialists for research and clinical studies. This newsletter and increased interest in neuro-anesthesia is a great opportunity to strengthen the collaboration between Belgian neuro-anesthetists.