Early Minimally Invasive Image Guided Endoscopic Evacuation of Intracerebral Haemorrhage

Inclusion Criteria: * No relevant disability prior to ICH (mRS 0-1 prior to ICH) * Primary supratentorial deep or superficial intraparenchymal ICH of volume ≥ 20 mL \< 100 mL (measured using formula) demonstrated on CT or MRI, with or without a 2 component of intraventricular haemorrhage * CT/MRI demonstrates ICH stability (\< 5 mL growth) at 6 hours after the admission scan if surgery is performed \>6 hours after admission CT * NIHSS ≥ 8 OR if a patient with a NIHSS\<8 presents with at least one of the following deficits: * a severe hemiparesis (4 motor points on the NIHSS for facial palsy, motoric upper and lower extremities combined); OR * a severe motor or sensory aphasia (2 points on the NIHSS); OR * a profound hemi-inattention (formerly neglect, 2 points on the NIHSS); OR * a decreased level of consciousness (GCS\<13) * Presenting GCS 5 - 15 * Endoscopic haematoma evacuation can be initiated within 24 hours of symptom onset * Systolic blood pressure can be controlled at \<160 mmHg Exclusion Criteria: * Imaging: * "Spot sign" identified on CT angiography (CTA) * Structural vascular or brain lesion as suspected cause of ICH, such as a vascular malformation (cavernous malformation, arteriovenous malformation (AVM) etc), aneurysm, neoplasm * Haemorrhagic conversion of an underlying ischemic stroke * Infratentorial haemorrhage * Large associated intra-ventricular haemorrhage requiring treatment for related mass effect or shift due to trapped ventricle (extraventricular drainage (EVD) for intracranial pressure (ICP) management is allowed) * Midbrain extension/involvement * Coagulation Issues: * Oral or parenteral therapeutic anticoagulation which cannot be pharmacologically reverted until the planned time of evacuation * Known hereditary or acquired haemorrhagic diathesis, coagulation factor deficiency * Platelet count \< 100 x 103 cells/mm3 or known platelet dysfunction * international normalized ratio (INR) \> 1.5 for any reason, elevated prothrombin time or activated partial thromboplastin time (aPTT), which cannot be corrected or otherwise accounted for (i.e., lupus anti-coagulant) * Presenting GCS 3 or 4 * Requirement for emergent surgical decompression or uncontrolled ICP after EVD * Unable to obtain consent from patient or appropriate surrogate (for patients without competence) * Pregnancy, breast-feeding, or positive pregnancy test \[either serum or urine\] (woman of child-bearing potential must have a negative history of current pregnancy prior to the study procedure) * Evidence of active infection (indicated by fever ≥38°C) at the time of study inclusion * Any comorbid disease or condition expected to compromise survival or ability to complete follow-up assessments through 180 days * Based on physician's judgment, patient does not have the necessary mental capacity to participate or is unwilling or unable to comply with protocol follow up appointment schedule * Active drug or alcohol use or dependence