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 …