Investigating unilateral and bilateral motor imagery control using electrocorticography and fMRI in awake craniotomy

• Enhanced understanding of brain function, crucial for BCI and Neurorehabilitation. • Analyzing brain activity during actual and imagined movements in awake craniotomy patients. • fMRI and ECoG to record brain activity during motor tasks and imagined movements. • The ipsilateral motor cortex shows significant patterns in bilateral motor imagination. • Insights into the role of the unilateral cerebral cortex in motor control, hemiplegic treatment, and BCI development. The rapid development of neurosurgical techniques, such as awake craniotomy, has increased opportunities to explore the mysteries of the brain. This is crucial for deepening our understanding of motor control and imagination processes, especially in developing brain–computer interface (BCI) technologies and improving neurorehabilitation strategies for neurological disorders. This study aimed to analyze brain activity patterns in patients undergoing awake craniotomy during actual movements and motor imagery, mainly focusing on the motor control processes of the bilateral limbs. We conducted detailed observations of patients undergoing awake craniotomies. The experimenter requested participants to perform and imagine a series of motor tasks involving their hands and tongues. Brain activity during these tasks was recorded using functional magnetic resonance imaging (fMRI) and intraoperative electrocorticography (ECoG). The study included left and right finger tapping, tongue protrusion, hand clenching, and imagined movements corresponding to these actions. fMRI revealed significant activation in the brain's motor areas during task performance, mainly involving bilateral brain regions during imagined movement. ECoG data demonstrated a marked desynchronization pattern in the ipsilateral motor cortex during bilateral motor imagination, especially in bilateral coordination tasks. This finding suggests a potential controlling role of the unilateral cerebral cortex in bilateral motor imagination. Our study highlights the unilateral cerebral cortex's significance in controlling bilateral limb motor imagination, offering new insights into future brain network remodeling in patients with hemiplegia. Additionally, these findings provide important insights into understanding motor imagination and its impact on BCI and neurorehabilitation.