Purpose: The purpose of this study is to present our surgical experience with symptomatic congenital cystic adenomatoid malformations (CCAMs) in neonates. Methods: The medical records of neonates who underwent surgery for symptomatic CCAM from 2010 to 2020 were retrospectively reviewed. Results: Of 24 cases, 10 involved open resection, and 14 involved thoracoscopic resection. Four cases of CCAMs located in the upper or middle lobes underwent lobectomy, and 20 cases underwent lung-preserving wedge resection in the lower lobe. Between the two groups, there was no statistically significant difference in related preoperative variables, including gestational age at birth, body weight, head circumference, lesion size, CVR, and age at operation (P>.05). The differences in intraoperative variables were statistically significant. The length of the surgical incision in the thoracoscopic resection group was significantly shorter than that in the open resection group (1.4 cm [1.3-1.8] vs 6.0 cm [5.0-8.0], P=.000), and there was significantly less operative blood loss (3 ml [1-6] vs 5 ml [2-10], P=.030), but the operation time was significantly longer (159 min [100-220] vs 110 min [70-170], P=.003). Regarding postoperative variables, ventilator days, duration of chest tube use and length of hospital stay were not statistically significant (P>.05). Conclusions: Thoracoscopic resection is a safe and favorable approach for symptomatic CCAM in neonates. It has minimal esthetic effects and does not increase the risk of surgical or postoperative complications. Lung-preserving resection is feasible for neonatal CCAM surgery.