BACKGROUND: Point-pair registration is widely used to register the patient and the image space in image-guided neurosurgery. The registration accuracy at the target point is influenced by the distribution of the fiducial points, and it is not always easy to achieve a good distribution in clinical practice. METHODS: We propose one original configuration and three variants of the distribution of the fiducial points, in which each fiducial point has a definite position on the head surface. These configurations are conceived by considering both the theoretical value of the target registration error (TRE) and practical constraints on the positioning of the fiducial points. These configurations can guide the surgeon to place fiducial points directly onto the patient's head. RESULTS: Experiments with real clinical data showed that when using the original configuration, the TRE in the whole skull was < 2 mm and the TRE in the whole brain was < 1.5 mm if the fiducial registration error was 2.5 mm. When using variants of the original configuration, small TRE can also be achieved in the corresponding surgical field. CONCLUSIONS: This study provides an easy-to-use approach to achieving good distribution of fiducial points in image-guided neurosurgery.