Bring a large pot of salted water to a rolling boil over high heat. Add the pasta and cook until al dente, about 8-10 minutes. Drain, reserving a cup of pasta water.

In a large skillet, heat a drizzle of olive oil over medium heat. Sauté the minced garlic for 1-2 minutes until fragrant.

Stir in the pumpkin puree and heavy cream, cooking for 3-5 minutes until warmed and combined.

Add fresh sage and cook for an additional minute, enhancing the flavors.

Incorporate grated parmesan cheese, stirring until melted and the sauce is creamy.

Add the drained pasta to the skillet, tossing to coat in the sauce. Use reserved pasta water to adjust sauce consistency if needed.

Taste and adjust seasoning with salt and pepper as desired.

Serve in bowls with additional parmesan and fresh sage for garnish.