Transcranial Ultrasound Via Sonolucent Cranioplasty After Minimally Invasive Intracerebral Hemorrhage Evacuation

Inclusion criteria:

* Presence of spontaneous supratentorial ICH ≥20 mL
* Age ≥18 years
* National Institute of Health Stroke Scale (NIHSS) score ≥6
* GCS score 5-15 at presentation
* Undergoing minimally invasive intracerebral hemorrhage evacuation with sonolucent cranioplasty or hemicraniectomy with sonolucent cranioplasty

Exclusion criteria:

* 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
* History of osteomyelitis
* History of skull neoplasm
* History of comminuted skull fractures
* Infratentorial hemorrhage
* Midbrain extension/involvement
* Coagulopathy defined as INR \> 1.4, elevated aPTT, or concurrent use of direct oral anticoagulants or low molecular weight heparin at ICH onset; known hereditary or acquired hemorrhagic diathesis; coagulation factor deficiency; platelet count \< 100x103cells/mm3, or known platelet dysfunction
* Inability to obtain consent from patient or appropriate surrogate (for patients without capacity)
* Evidence of active infection indicated by fever ≥ 100.7F and/or open draining wound at the time of enrolment
* Any comorbid disease or condition expected to compromise survival or ability to complete follow-up assessments through 1 year
* 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 appointment schedule
* Active drug or alcohol abuse that, in the opinion of the site investigator, would interfere with adherence to study enrolments
* Pre-existing DNR/DNI status