Boil a pot of salted water and cook the pasta according to package directions until al dente, about 8-10 minutes. Drain and set aside.

In a large skillet over medium heat, add olive oil and heat until shimmering. Add the Italian sausage, breaking it apart with a wooden spoon, and cook until browned and crispy, around 5-7 minutes.

Add the diced onion to the skillet and sauté for about 3-4 minutes until translucent. Stir in the minced garlic and cook for an additional minute until fragrant.

Stir in the diced butternut squash and allow it to cook for about 3-4 minutes, then pour in the vegetable broth, seasoning with salt and pepper to taste, and bring to a gentle simmer.

Add the drained pasta to the skillet and stir to combine. Gradually pour in the heavy cream, stirring until everything is evenly coated. Heat through for about 2 minutes.

Remove from heat and fold in the grated Parmesan cheese, adjusting the seasoning as needed. Serve in bowls, garnished with extra cheese and fresh herbs if desired.