An Augmented Reality-Based Navigation System for Stereotactic Brain Biopsy with Multi-Objective Path Planning and Hybrid Registration

Background: Stereotactic brain biopsy is the gold standard for the pathological diagnosis of malignant brain tumors. However, conventional procedures rely heavily on manual path planning and unintuitive navigation, which significantly increase the risk of severe complications and impose an additional cognitive burden on surgeons. Methods: We propose an augmented reality-based navigation system that synergizes multi-objective path planning with hybrid registration. Preoperatively, the system utilizes a constrained multi-objective optimization (MOO) model derived from clinical criteria to automatically calculate and visualize optimal biopsy paths within a three-dimensional anatomical environment. Intraoperatively, the system performs rapid initial alignment using quick response (QR) codes, followed by precise refinement through anatomical landmarks. This process ultimately enables the highly accurate, real-time overlay of the surgical path and anatomical models onto the patient’s operative field. Results: An expert study across four common brain tumor locations demonstrated that the MOO model significantly outperformed manual methods in satisfying safety criteria. The hybrid registration reduced the mean fiducial registration error (FRE) from 4.19 ± 1.11 mm to 2.37 ± 0.91 mm (p < 0.001), with a mean target registration error (TRE) of 2.34 ± 0.71 mm and a mean clinical setup time of 2.63 ± 0.36 min. Conclusions: This system assists stereotactic brain biopsy through automated path planning and immersive augmented reality-based guidance, highlighting its potential to support surgical workflow consistency and procedural safety.