Background: Mastery of microsurgical skills requires regular hands-on practice. Simulation is increasingly recognized as an important supplement to operative training experience. The live rat femoral artery model is the gold standard model for microneurosurgical skills simulation. We present an 11-year experience incorporating simulation-based microsurgical training into an established Canadian neurosurgery program. Methods: Postgraduate year 2 (PGY-2) neurosurgery residents completed a one-year curriculum spanning 17 training sessions divided into 5 modules of increasing fidelity. Both perfused duck wing and live rat vessel training modules were used. Three modules comprised live microvascular anastomosis. Trainee performance was video recorded and blindly graded using the Objective Structured Assessment of Technical Skills Global Rating Scale. Results: Eighteen participants completed 107 microvascular anastomoses. There was significant improvement in six measurable skills during the curriculum. Mean overall score was significantly higher on the fifth attempt compared to the first attempt for all 3 live anastomotic modules (p<0.001). Each module had a different improvement profile across the skills assessed. The greatest improvement was observed during artery-to-artery anastomosis. Conclusions: This high-fidelity microsurgical simulation curriculum demonstrated a significant improvement in the six microneurosurgical skills assessed, supporting its use as an effective teaching model. Transferability to the operative environment is actively being investigated.