Chiari-like malformation and syringomyelia (CMSM) are a disease complex commonly recognized in Cavalier King Charles spaniels (CKCS) and the Griffon Bruxellois, but present in many small breed dogs. Since its description in 2000, we have struggled to recognize and quantify the full spectrum of signs associated with the disease. This presentation will cover a logical approach to treatment using a wide range of different strategies.