Neuroprotective strategies for atrial myxoma resection surgery in a child with cerebral infarction from embolic stroke

Cardiac myxoma is a rare benign primary cardiac tumor in children with a high risk of cerebral embolization due to its friable and mobile nature. We present a child who developed an acute left middle cerebral artery infarct from embolization from a left atrial myxoma. He underwent decompressive craniectomy followed by myxoma resection 5 days later. Perioperative management focused on neuroprotection, including mild hypothermia, cerebral oximetry monitoring, and optimized hemodynamic and metabolic parameters. No hemorrhagic complications occurred, and the patient had a favorable neurological recovery without tumor recurrence. In myxoma-related embolic stroke, surgical resection remains the definitive treatment. Although the timing of surgery remains debated, delaying surgery even with antithrombotic bridging still poses a risk of recurrent embolism. With multidisciplinary coordination to balance the risks of hemorrhagic transformation and further embolization, early surgery can be both safe and effective.