Aim: To report a successful transarterial Onyx embolization of a highly vascularized sacral chordoma.
Case presentation: A 74-year-old patient presented with progressive lower back pain and anorectal and urogenital dysfunction complicated by excessive intraoperative blood loss requiring emergent endovascular intervention.
Intervention: Emergent pelvic angiography demonstrated a highly vascularized sacral chordoma. Transarterial embolization with Onyx was performed successfully via a single arterial pedicle, the median sacral artery. Surgical extirpation was achieved with the expected amount of intraoperative blood loss without further complications.
Conclusion: Preoperative transarterial Onyx embolization can be performed safely and effectively to assist in the surgical resection of sacral chordomas.