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Background and Objective: The exact localization of pathological anatomy is the basis of a successful operation. Malformations, tumors, or previous operations can make intraoperative orientation considerably more difficult. Navigation systems can be useful tools in such cases., Methods: The OTS is an optoelectrical navigation system which was used on 34 patients with disorders of the skull base region. Clinical accuracy, practicability, and intraoperative usefulness of the system were evaluated., Results: In clinical use, an accuracy of approximately 1.5 mm could only be achieved with the use of head fixation and bone-anchored reference markers. When using the VBH mouthpiece for dynamic referencing with flexible head positioning, deviations of less than 2 mm were observed. The preoperative preparation time was 15-25 min, depending on the operation schedule., Conclusions: The intraoperative orientation system represents a significant aid for orientation, particularly where anatomical alterations are present. Further modifications to improve both accuracy and the integration of the system into working practice are, however, essential.