Preheat oven to 400F. Cook pasta noodles according to package, drain, and set aside.
In a large dutch oven or skillet, heat over medium high heat and spray with non-stick spray. Add sausage. Break up with wooden spoon as it is cooking and turn off heat once no longer pink. Remove sausage and drain any excess grease.
Turn heat back to medium-high and add 2 tablespoon butter to pan. Add in onions, butternut squash, and shredded brussels. Then mix in sage, tomato paste, salt, pepper, garlic powder and red pepper flake. Let cook for 10 minutes, stirring every few minutes.
Pour in chicken stock and heavy cream, then parmesan cheese. Add sausage back in. Bring to a low simmer and let cook about 5 minutes.
Turn off heat and stir in pasta noodles. Pour into a 9x13 casserole dish.
Top with gruyere or mozzarella cheese and more sage. Bake for 20 minutes, broiling for a few minutes at the end to get a nice crispy crust on the cheese. Let cool 10 minutes before serving.