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.