From its beginning surgical tomography developed rapidly. The possibility to identify every structure inside the body and to guide instruments with monitoring of tissue changes increase safety. Different therapies have been performed under CT and MRI guidance and evaluated in studies, like biopsies, tumor pain therapy and treatments of tumors as well as treatments of the spine. The results show that surgical tomography is an accurate guiding technique. Especially in combination with micro endoscopy offers a new way of surgery. The complication rate as well as the frequency of side effects is very low.