To the Editor: We read with great interest the paper “Management of Sigmoid Sinus Injury: Retrospective Study of 450 Consecutive Surgeries in the Cerebellopontine Angle and Intrapetrous Region” by Matsushima et al.1 The authors clearly highlighted a very important issue when performing cerebellopontine angle (CPA) surgery, both in cases of simple (such as retrosigmoid or far lateral) and in cases of more complex (transmastoid, translabyrinthic, inframeatal, transcondylar) approaches. We really appreciate the described fine surgical techniques for repairing the injuries, considering these a very important cultural heritage each neurosurgeon should possess. Since the anatomy of the CPA can present several anatomic variants, we usually perform a preoperative computed tomography (CT) or magnetic resonance imaging (MRI) for neuronavigation, in order to better plan the craniotomy and depict the course of the venous sinuses. Moreover, in extensions of the suboccipital retrosigmoid approach,2,3 when the drilling of the petrous bone is planned, we also carefully evaluate the position of the jugular bulb. Indeed, the incidence of high jugular bulb is about 9%,4,5 and it can represent an obstacle when performing transmastoid approaches. Since the authors1 reported their experience of venous injuries in a very large population of patients undergoing CPA surgery, we would like to know in how many patients they performed a preoperative CT or MRI for neuronavigation, if this, in their opinion, allowed to significantly reduce the incidence of injuries and if they ever experienced a high jugular bulb injury. Finally, we really thank Matsushima et al for reporting their large experience in a clear and very educative manner. Funding This study did not receive any funding or financial support. Disclosures The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.