Minimally Invasive Neuroendoscopic Ultra-Early Targeted ICH Evacuation

Inclusion Criteria: * Age ≥ 18 and ≤ 80 years * Non-traumatic, spontaneous, supratentorial, non-thalamic, BGH of volume ≥ 20 mL, as determined by the treating physician using ABC/2 method * NIHSS ≥ 6 at presentation * Computed Tomography Angiography (CTA) or Magnetic Resonance Angiography (MRA) is performed and does not show an underlying vascular lesion * Pre-ICH mRS 0-2 Informed consent from patient or legally authorized representative (LAR) to participate in the trial, wherein patient/LAR's stated wishes are to pursue lifesaving therapies as opposed to early withdrawal of care (explicitly explained as \<7 days following ictus) * The treating physician anticipates that surgery can be initiated \<120 min from randomization * Randomization can occur ≤16 hours from LKW Exclusion Criteria: * Suspected secondary cause for the ICH, such as an underlying vascular malformation (cavernous malformation, arteriovenous malformation, etc.), aneurysm, neoplasm, hemorrhagic transformation of an underlying ischemic infarct; or venous infarct Infratentorial or thalamic hemorrhage * Midbrain extension/involvement * Coagulopathy defined as international normalized ratio (INR) \> 1.4 * Elevated activated Partial Thromboplastin Time (aPTT) \> 40 s * Concurrent use of direct oral anticoagulants or low molecular weight heparin at ICH onset * Known hereditary or acquired hemorrhagic diathesis or coagulation factor deficiency * Platelet count \<100 x 103 cells/mm3, or known platelet dysfunction (reversal of coagulopathy is not allowed) GCS score \<7 at presentation * Evidence of active infection indicated by fever ≥100.7 °F and/or open draining wound at the time of enrollment * Any comorbid disease or condition expected to compromise survival or ability to complete follow-up assessments through 365 days * Intraventricular extension of the hemorrhage is visually estimated to involve \> 50% of either of the lateral ventricles * Pregnancy (women of childbearing potential must have a negative pregnancy test to participate) * Based on investigator's judgment, the patient does not have the necessary mental capacity to participate or is unwilling to comply with the protocol follow-up schedule * Current participation in another interventional (drug or device) trial * Pre-existing Do Not Resuscitate (DNR)/Do Not Intubate (DNI) status * History of severe dementia