Telepathology has emerged in recent years as a viable solution for providing rapid expert subspecialty consultations to geographically dispersed sites. The Neuropathology Division at the University of Pittsburgh Medical Center has utilized telepathology systems for the past 7 years to perform intraoperative consultations for neurosurgeons at a separate hospital. In 2007 the division switched to a next-generation dynamic robotic system with additional features, including higher resolution, faster image transmission speed, fine-focus control using the mouse fingerwheel, and multiple slide holding capacity. The diagnostic outcomes from a total of 262 intraoperative consultations performed using this new system are compared with 159 consultations using the prior system in 2006 and with outcomes from over 900 conventional consultations from 2006-2008. These results show that telepathology can be used to diagnose challenging tumors, and that differences in outcomes are as much a function of the different surgeries performed at different sites as is the diagnostic modality used.